Suicide and drought in New South Wales, Australia, 1970-2007

Impact of drought on mental and behavioral disorders, contributions of research in a climate change context. A narrative review

Mental and behavioral disorders are an important public health problem and constitute a priority for the WHO, whose recommendations include the surveillance of their risk factors. On the other hand, drought episodes have been increasing in frequency and severity in Europe since 1980. Therefore, to review the present knowledge about the impact of drought on mental and behavioral disorders, in the present climate change context, and to underline potential research gaps, could be of major interest. Thus, we performed a narrative review using online academic databases with the aim of identifying relevant literature about the impact of drought on mental and behavioral disorders. To the best of our knowledge, no study in Europe quantifies the potential association between drought and mental disorders. A limited number of studies have found significant associations between droughts (with different temporal ranges) and various measures of mental health. However, according to our review, only three of them quantified the association between drought and objective mental health outcomes, such as number of emergencies due to clinically diagnosed mental disorders or suicides. Additionally, few studies used specific indices as a measure of drought; and finally, as far as authors are aware, none of them has analyzed this relationship adjusting for various other potential environmental confounders. Moreover, the eventual association could vary between different geographical areas within the same country. Therefore, national and regional studies would be especially necessary. Thus, there is a need for specific national and regional studies, in Europe and globally, that assess the impact of specific indices of drought (with different temporal ranges) on objective mental health outcomes controlling for potential environmental confounders. Moreover, the quantification of its cost would be necessary for health prioritization, evidence-based policies and strategic health planning.

Existing Challenges and Opportunities for Advancing Drought and Health Research

PURPOSE OF REVIEW

Drought is one of the most far-reaching natural disasters, yet drought and health research is sparse. This may be attributed to the challenge of quantifying drought exposure, something complicated by multiple drought indices without any designed for health research. The purpose of this general review is to evaluate current drought and health literature and highlight challenges or scientific considerations when performing drought exposure and health assessments.

RECENT FINDINGS

The literature revealed a small, but growing, number of drought and health studies primarily emphasizing Australian, western European, and US populations. The selection of drought indices and definitions of drought are inconsistent. Rural and agricultural populations have been identified as vulnerable cohorts, particularly for mental health outcomes. Using relevant examples, we discuss the importance of characterizing drought and explore why health outcomes, populations of interest, and compound environmental hazards are crucial considerations for drought and health assessments. As climate and health research is prioritized, we propose guidance for investigators performing drought-focused analyses.

Environmental pollution and extreme weather conditions: insights into the effect on mental health

Environmental pollution exposures, including air, soil, water, light, and noise pollution, are critical issues that may implicate adverse mental health outcomes. Extreme weather conditions, such as hurricanes, floods, wildfires, and droughts, may also cause long-term severe concerns. However, the knowledge about possible psychiatric disorders associated with these exposures is currently not well disseminated. In this review, we aim to summarize the current knowledge on the impact of environmental pollution and extreme weather conditions on mental health, focusing on anxiety spectrum disorders, autism spectrum disorders, schizophrenia, and depression. In air pollution studies, increased concentrations of PM2.5, NO2, and SO2 were the most strongly associated with the exacerbation of anxiety, schizophrenia, and depression symptoms. We provide an overview of the suggested underlying pathomechanisms involved. We highlight that the pathogenesis of environmental pollution-related diseases is multifactorial, including increased oxidative stress, systematic inflammation, disruption of the blood-brain barrier, and epigenetic dysregulation. Light pollution and noise pollution were correlated with an increased risk of neurodegenerative disorders, particularly Alzheimer's disease. Moreover, the impact of soil and water pollution is discussed. Such compounds as crude oil, heavy metals, natural gas, agro-chemicals (pesticides, herbicides, and fertilizers), polycyclic or polynuclear aromatic hydrocarbons (PAH), solvents, lead (Pb), and asbestos were associated with detrimental impact on mental health. Extreme weather conditions were linked to depression and anxiety spectrum disorders, namely PTSD. Several policy recommendations and awareness campaigns should be implemented, advocating for the advancement of high-quality urbanization, the mitigation of environmental pollution, and, consequently, the enhancement of residents' mental health.

Analyzing the effects of drought at different time scales on cause-specific mortality in South Africa

South Africa (SA) is highly vulnerable to the effects of drought on the environment, economy, and society. However, its effect on human health remains unclear. Understanding the mortality risk associated with different types of droughts in different population groups and by specific causes would help clarify the potential mechanisms involved. The study aims to comprehensively assess the effect of droughts of varying time scales on cause-specific mortality (all; infectious and parasitic; endocrine, nutritional, and metabolic; cardiovascular; respiratory) in SA (from 2009-2016) and identify more vulnerable profiles based on sex and age. We also evaluated the urbanicity and district-level socioeconomic deprivation as potential risk modifiers. We used a two-stage time-series study design, with the weekly standardized precipitation-evapotranspiration index (SPEI) calculated at 1, 6, 12, and 15 months of accumulation to identify droughts of different duration (SPEI1, 6, 12, 15, respectively). We applied a quasi-Poisson regression adjusted by mean temperature to assess the association between each type of drought and weekly mortality in all district municipalities of SA, and then pooled the estimates in a meta-regression model. We reported relative risks (RRs) for one unit increase of drought severity. Overall, we found a positive association between droughts (regardless the time scale) and all causes of death analyzed. The strongest associations were found for the drought events more prolonged (RR [95%CI]: 1.027 [1.018, 1.036] (SPEI1); 1.035 [1.021, 1.050] (SPEI6); 1.033 [1.008, 1.058] (SPEI12); 1.098 [1.068, 1.129] (SPEI15)) and respiratory mortality (RRs varied from 1.037 [1.021, 1.053] (SPEI1) to 1.189 [1.14, 1.241] (SPEI15)). An indication of greater vulnerability was found in younger adults for the shortest droughts, in older adults for medium-term and long-term droughts, and children for very long-term droughts. However, differences were not significant. Further evidence of the relevance of urbanicity and demographic and socioeconomic conditions as potential risk modifiers is needed.

Trauma systems in high socioeconomic index countries in 2050

Considerable political, structural, environmental and epidemiological change will affect high socioeconomic index (SDI) countries over the next 25 years. These changes will impact healthcare provision and consequently trauma systems. This review attempts to anticipate the potential impact on trauma systems and how they could adapt to meet the changing priorities. The first section describes possible epidemiological trajectories. A second section exposes existing governance and funding challenges, how these can be met, and the need to incorporate data and information science into a learning and adaptive trauma system. The last section suggests an international harmonization of trauma education to improve care standards, optimize immediate and long-term patient needs and enhance disaster preparedness and crisis resilience. By demonstrating their capacity for adaptation, trauma systems can play a leading role in the transformation of care systems to tackle future health challenges.

A 'Vocal Locals' social network campaign is associated with increased frequency of conversations about mental health and improved engagement in wellbeing-promoting activities in an Australian farming community

BACKGROUND

Farmers face numerous barriers to accessing professional mental health services and instead report a preference for informal support systems, such as lay or peer networks. Farmers also experience barriers to investing time in maintaining or improving their wellbeing, stemming from sociocultural norms and attitudes that are widespread in agricultural communities. The Vocal Locals social network campaign is an ifarmwell initiative that aims to promote conversations about wellbeing and challenge attitudes and behaviours that contribute to farmers' poor mental health.

METHODS

The Vocal Locals campaign was underpinned by the socio-ecological model which explains human behaviour as stemming from interactions between the individual, their closest social circle, the community, and broader society. The campaign ran in Loxton, South Australia, from June to August 2022. Ten community members (8/10 farmers) became 'Vocal Locals' and were supported to share 'calls-to-action' to encourage people in their social networks to engage in wellbeing-promoting activities. A broader communications campaign reinforced key messages and amplified Vocal Locals' activities in the community. The intrapersonal and community-level impacts of the campaign were evaluated via pre- and post-campaign surveys of Vocal Locals and community members respectively.

RESULTS

Vocal Locals reported significantly lower psychological distress (p = .014), and higher positive mental wellbeing (p = .011), levels of general mental health knowledge (p = .022), and confidence helping someone with poor mental health (p = .004) following the intervention. However, changes in stigmatising beliefs about mental illness, confidence recognising poor mental health, and confidence and comfort speaking to others about mental health were non-significant. Community members who were familiar with the campaign reported having significantly more wellbeing-related conversations post-campaign compared to before (p = .015). Respondents also reported being more comfortable speaking to others about mental health or wellbeing (p = .001) and engaging more in activities to maintain or improve their wellbeing (p = .012) following the campaign.

CONCLUSIONS

The Vocal Locals social network campaign is an example of how science and community can be brought together to achieve meaningful outcomes. The campaign may serve as a model for others who wish to challenge attitudinal or knowledge-related barriers to help-seeking and improve engagement in wellbeing-promoting activities in difficult-to-reach communities.

The perspectives of nurses, as prominent advocates in sustainability, on the global climate crises and its impact on mental health

OBJECTIVE

To evaluate the perspective of nurses in Turkey towards the global climate crisis and its impact on mental health using a qualitative approach.

MATERIALS AND METHOD

This study was conducted from August to September 2023 with 35 nurses living in seven regions of Turkey using an inductive qualitative approach. The researchers employed the snowball sampling method to select participants. Interviews with the participants were conducted until data saturation was reached. Thematic analysis was used to emerge themes.

RESULTS

The findings revealed five main themes (perception of the global climate crisis, effects of the global climate crisis, effects of the global climate crisis on mental health, reflections of the global climate crisis on nursing and nurses' views on prevention and intervention studies for the global climate crisis). Also, the findings revealed 12 sub-themes (physical outcomes, mental outcomes, direct and indirect impacts, psychosocial effects and personal, national and international-based reflections).

CONCLUSION

Our study indicates that nurses exhibit genuine concern for the global climate crisis and experience psychological effects related to this pressing environmental issue. Nurses are keenly aware of their responsibility to safeguard the planet and demonstrate a strong sense of concern for the state of the world.

IMPACT

It is evident that nurses, being prominent advocates for sustainability, are cognizant of their responsibility to protect the planet and demonstrate genuine apprehension for the state of the world.

IMPLICATIONS

Nurses play a crucial role, as they make up 60% of the global healthcare workforce and are often the frontline healthcare professionals during natural disasters. It is vital to elucidate and clarify the terminology concerning the relationship between the climate crisis and the mental health of nurses, to determine the scope of this relationship and to make recommendations for future research areas.

PATIENT OR PUBLIC CONTRIBUTION

No patient or Public Contribution.

Mental Health Impacts of Climate Change Among Vulnerable Populations Globally: An Integrative Review

Background

Climate change has been shown to be directly linked to multiple physiological sequelae and to impact health consequences. However, the impact of climate change on mental health globally, particularly among vulnerable populations, is less well understood.

Objective

To explore the mental health impacts of climate change in vulnerable populations globally.

Methods

We performed an integrative literature review to identify published articles that addressed the research question: What are the mental health impacts of climate change among vulnerable populations globally? The Vulnerable Populations Conceptual Model served as a theoretical model during the review process and data synthesis.

Findings/Results

One hundred and four articles were selected for inclusion in this review after a comprehensive review of 1828 manuscripts. Articles were diverse in scope and populations addressed. Land-vulnerable persons (either due to occupation or geographic location), Indigenous persons, children, older adults, and climate migrants were among the vulnerable populations whose mental health was most impacted by climate change. The most prevalent mental health responses to climate change included solastalgia, suicidality, depression, anxiety/eco-anxiety, PTSD, substance use, insomnia, and behavioral disturbance.

Conclusions

Mental health professionals including physicians, nurses, physician assistants and other healthcare providers have the opportunity to mitigate the mental health impacts of climate change among vulnerable populations through assessment, preventative education and care. An inclusive and trauma-informed response to climate-related disasters, use of validated measures of mental health, and a long-term therapeutic relationship that extends beyond the immediate consequences of climate change-related events are approaches to successful mental health care in a climate-changing world.

Online mental health screening for rural fathers over the perinatal period

OBJECTIVE

To determine the feasibility of identifying distressed fathers in rural areas of NSW via a 'light touch' support program (SMS4dads).

DESIGN

A retrospective observational study using self-reported distress and routinely captured help-seeking behaviour over a 14-month period (September 2020-December 2021) comparing rural and urban fathers.

SETTING

Rural and urban Local Health Districts in NSW.

PARTICIPANTS

A total of 3261 expectant and new fathers enrolled in a text-based information and support service (SMS4dads).

MAIN OUTCOME MEASURES

Registrations, K10 score, program engagement, attrition, escalation and referral to online mental health services.

RESULTS

Rural (13.3%) and urban (13.2%) enrolments were equivalent. Rural fathers had higher rates of distress than urban fathers (rural 19%; urban 16%) and were more likely to be smokers, consume alcohol at risky levels and report lower education levels. Rural fathers were more likely to exit the program early (HR = 1.32; 95% CI 1.08-1.62; p = 0.008); however, once adjusted for demographic factors aside from rurality, this increased likelihood was nonsignificant (HR = 1.10; 95% CI 0.88-1.38; p = 0.401). Although engagement with psychological support during the program was equivalent, a greater proportion of rural participants were escalated to online mental health support (7.7%) than urban participants (6.1%); however, this was nonsignificant (p = 0.222).

CONCLUSION

Digital platforms offering text-based parenting information in a 'light touch' format may be an effective way to screen rural fathers for mental distress and connect them to online support.

Impacts of Climate Change on Health and Health Services in Northern New South Wales, Australia: A Rapid Review

Climate change is exposing populations to increasing temperatures and extreme weather events in many parts of Australia. To prepare for climate challenges, there is a growing need for Local Health Districts (LHDs) to identify potential health impacts in their region and strengthen the capacity of the health system to respond accordingly. This rapid review summarised existing evidence and research gaps on the impact of climate change on health and health services in Northern New South Wales (NSW)-a 'hotspot' for climate disaster declarations. We systematically searched online databases and selected 11 peer-reviewed studies published between 2012-2022 for the Northern NSW region. The most explored health outcome was mental health in the aftermath of floods and droughts, followed by increased healthcare utilisation due to respiratory, cardiovascular and mortality outcomes associated with bushfire smoke or heat waves. Future research directions were recommended to understand: the compounding impacts of extreme events on health and the health system, local data needs that can better inform models that predict future health risks and healthcare utilisation for the region, and the needs of vulnerable populations that require a whole-of-system response during the different phases of disasters. In conclusion, the review provided climate change and health research directions the LHD may undertake to inform future adaptation and mitigation policies and strategies relevant to their region.

The psychosocial impact of climate change among smallholder farmers: a potential threat to sustainable development

Psychosocial impacts of climate change and implications on sustainable development remain unclear. This problem was addressed focusing on smallholder farmers in resettlement areas of Chirumanzu District, Zimbabwe. An Exploratory Descriptive Qualitative research design was adopted. Purposive sampling techniques were used to select 54 farmers who served as main respondents from four representative wards. Data were collected through semi-structured interviews and analyzed using a grounded theory approach. Code groups and codes were established through inductive approaches considering narratives of farmers. Forty psychosocial impacts were established. They were qualitative, intangible, indirect and difficult to measure quantitatively. Farmers agonized over the threat of climate change on farming operations, felt humiliated, and embarrassed over detestable practices they resorted to due to climate change. Some farmers experienced heightened negative feelings, thoughts, and emotions. It was established that psychosocial impacts of climate change have a bearing on sustainable development of emerging rural communities.

Investigating the Health Impacts of Climate Change among People with Pre-Existing Mental Health Problems: A Scoping Review

Climate change is the greatest threat to global public health, although the impacts on mental health are relatively understudied. Furthermore, there is a lack of consensus about the effects of climate change on individuals with pre-existing mental health problems. This review aimed to identify the health impacts of climate change on people with pre-existing mental health problems. The search was conducted across three databases; studies were included if they involved participants who had mental health problem(s) before a climate-driven event and reported on health outcomes post-event. A total of thirty-one studies met the full inclusion criteria. The study characteristics included 6 climate-driven events: heat events, floods, wildfires, wildfire and flood, hurricanes, and droughts, and 16 categories of pre-existing mental health problems, with depression, and non-specified mental health problems being the most common. The majority of the studies (90%, n = 28) suggest an association between the presence of pre-existing mental health problems and the likelihood of adverse health impacts (e.g., increased mortality risk, new symptom presentation, and an exacerbation of symptoms). To mitigate the exacerbation of health inequalities, people with pre-existing mental health problems should be included in adaption guidance and/or plans that mitigate the health impacts of climate change, future policy, reports, and frameworks.

Climate change and mental health: time for action and advocacy

Climate change poses an existential threat to our planet and our health. We explore the intersections of climate change and mental health which has been under-recognised to date. Climate change can affect mental health directly through the effects of extreme weather events such as heat, drought and flooding, and indirectly through increasing rates of migration and inequality. Vulnerable individuals with neuropsychiatric disorders will be particularly at risk. Emerging evidence is also showing effects of air pollution on brain development. Mitigation efforts related to reducing carbon emissions will have both direct and indirect effects on mental health. A further consideration demonstrated by the COVID-19 pandemic is that the spread of infectious disease can have substantial effects on the mental health of the population. With climate change and biodiversity loss, pandemics could recur in the future with increasing frequency. It is now essential that mental health professionals be equipped as agents for climate action.

Developing Psychological Resilience to the Impact of Drought

BACKGROUND

Drought is a slow-onset natural hazard with significant socioeconomic, environmental and psychological impacts. The extant literature has predominately focused on the physical and economic dimensions of resilience, which mainly address the socioeconomic and environmental consequences of drought. However, the mental health effects of chronic environmental adversity, such as prolonged drought, remain an under-researched area, and frameworks that build and strengthen the psychological aspect of the social resilience of communities are lacking.

METHODS

This feasibility study will employ a mixed-method design sub-divided into three phases. Phase 1 will utilise social network analysis (SNA) to identify leadership patterns and their intersections across communities. While phase 2 will use semi-structured interviews to ascertain the perceived roles of identified leaders in preparing for and recovering from drought impacts, the third phase will adopt the Delphi method to unpack existing perceptions of control, coherence and connectedness.

Effects of climate-related risks and extreme events on health outcomes and health utilization of primary care in rural and remote areas: a scoping review

BACKGROUND

Rural populations are at risk of climate-related impacts due to ecological and geographical determinants, potentially leading to greater morbidity and health utilization. They are often highly dependent on primary care services. However, no rural- or primary care specific synthesis of these issues has ever been conducted. This review aimed to identify, characterize, and summarize existing research on the effects of climate-related events on utilization and health outcomes of primary care in rural and remote areas and identify related adaptation strategies used in primary care to climate-related events.

METHODS

A scoping review following PRISMA-ScR guidelines was conducted, examining peer-reviewed English-language articles published up to 31 October 2022. Eligible papers were empirical studies conducted in primary care settings that involved climate-related events as exposures, and health outcomes or utilization as study outcomes. Two reviewers independently screened and extracted relevant information from selected papers. Data were analysed using content analysis and presented using a narrative approach.

RESULTS

We screened 693 non-duplicate papers, of those, 60 papers were analysed. Climate-related events were categorized by type, with outcomes described in terms of primary, secondary, and tertiary effects. Disruption of primary care often resulted from shortages in health resources. Primary care may be ill-prepared for climate-related events but has an important role in supporting the development of community.

CONCLUSIONS

Findings suggest various effects of climate-related events on primary care utilization and health outcomes in rural and remote areas. There is a need to prepare rural and remote primary care service before and after climate-related events.

A Systematic Literature Review of the Impact of Climate Change on the Global Demand for Psychiatric Services

Climate Change (CC) imposes important global health risks, including on mental health (MH). They are related mostly to psychological suffering caused by climate-related events and to the heat-vulnerability caused by psychiatric disorders. This growing burden may press MH services worldwide, increasing demand on public and private systems in low-, middle-, and high-income countries. According to PRISMA, two independent reviewers searched four databases for papers published before May 2022 that associated climate-related events with healthcare demand for psychiatric conditions. Of the 7432 papers retrieved, we included 105. Only 29 were carried out in low- and middle-income countries. Twelve related the admission numbers to (i) extreme events, while 93 to (ii) meteorological factors-mostly heat. Emergency visits and hospitalizations were significantly higher during hot periods for MH disorders, especially until lag 5-7. Extreme events also caused more consultations. Suicide (completed or attempted), substance misuse, schizophrenia, mood, organic and neurotic disorders, and mortality were strongly affected by CC. This high healthcare demand is evidence of the burden patients may undergo. In addition, public and private services may face a shortage of financial and human resources. Finally, the increased use of healthcare facilities, in turn, intensifies greenhouse gas emissions, representing a self-enforcing cycle for CC. Further research is needed to better clarify how extreme events affect MH services and, in addition, if services in low- and middle-income countries are more intensely demanded by CC, as compared to richer countries.

The role of meteorological factors in suicide mortality in Wuhu, a humid city along the Yangtze River in Eastern China

As the climate continues to change, suicide is becoming more frequent. In this study, absolute humidity (AH) was included for the first time and Wuhu, a typical subtropical city along the Yangtze River, was taken as the research object to explore the impact of suicide death risk on meteorological factors. The daily meteorological factors and suicide mortality data of Wuhu city from 2014 to 2020 were collected. Guided by structural equation model (SEM), a time series analysis method combining distributed lag nonlinear model (DLNM) and generalized additive model (GAM) was adopted. To investigate the correlation among different populations, we stratified age and gender at different meteorological levels. A total of 1259 suicide deaths were collected in Wuhu. The results indicated that exceedingly low and low levels of AH short-term exposure increased suicide mortality, with the maximum effect occurring at lag 14 for both levels of exposure, when the relative risk (RR) was 1.131 (95% CI: 1.030, 1.242) and 1.065 (95% CI: 1.006, 1.127), respectively. Exposure to exceedingly high and exceedingly low levels of temperature mean (T mean) also increased suicide mortality, with maximum RR values of 1.132 (lag 14, 95% CI: 1.015, 1.263) and 1.203 (lag 0, 95% CI: 1.079, 1.340), sequentially. As for diurnal temperature range (DTR), low-level exposure decreased the risk of suicide, while high-level exposure increased this risk, with RR values of 0.955 (lag 0, 95% CI: 0.920, 0.991, minimum) and 1.060 (lag 0, 95% CI: 1.018, 1.104, maximum), sequentially. Stratified analysis showed that AH and DTR increased the suicide death risk in male and elderly people, while the risk effect of T mean have no effect on young people only. In summary, male and elderly people appear to be more vulnerable to adverse weather effects.

Climate Change and Mental Health: A Review of Empirical Evidence, Mechanisms and Implications

Anthropogenic climate change is an existential threat whose influences continue to increase in severity. It is pivotal to understand the implications of climate change and their effects on mental health. This integrative review aims to summarize the relevant evidence examining the harm climate change may have on mental health, suggest potential mechanisms and discuss implications. Empirical evidence has begun to indicate that negative mental health outcomes are a relevant and notable consequence of climate change. Specifically, these negative outcomes range from increased rates of psychiatric diagnoses such as depression, anxiety and post-traumatic stress disorder to higher measures of suicide, aggression and crime. Potential mechanisms are thought to include neuroinflammatory responses to stress, maladaptive serotonergic receptors and detrimental effects on one's own physical health, as well as the community wellbeing. While climate change and mental health are salient areas of research, the evidence examining an association is limited. Therefore, further work should be conducted to delineate exact pathways of action to explain the mediators and mechanisms of the interaction between climate change and mental health.

Drought and all-cause mortality in Nebraska from 1980 to 2014: Time-series analyses by age, sex, race, urbanicity and drought severity

BACKGROUND

Climate change will increase drought duration and severity in many regions around the world, including the Central Plains of North America. However, studies on drought-related health impacts are still sparse. This study aims to explore the potential associations between drought and all-cause mortality in Nebraska from 1980 to 2014.

METHODS

The Evaporative Demand Drought Index (EDDI) were used to define short-, medium- and long-term drought exposures, respectively. We used a Bayesian zero-inflated censored negative binomial (ZICNB) regression model to estimate the overall association between drought and annual mortality first in the total population and second in stratified sub-populations based on age, race, sex, and the urbanicity class of the counties.

RESULTS

The main findings indicate that there is a slightly negative association between all-cause mortality and all types of droughts in the total population, though the effect is statistically null. The joint-stratified analysis renders significant results for a few sub-groups. White population aged 25-34 and 45-64 in metro counties and 45-54 in non-metro counties were the population more at risk in Nebraska. No positive associations were observed in any race besides white. Black males aged 20-24 and white females older than 85 showed protective effect against drought mainly in metro counties. We also found that more sub-populations had higher rates of mortality with longer-term droughts compared to shorter-term droughts (12-month vs 1- or 6-month timescales), in both metro and non-metro counties, collectively.

CONCLUSION

Our results suggest that mortality in middle aged white population in Nebraska shows a greater association with drought. Moreover, women aged 45-54 were more affected than men in non-metro counties. With a projected increase in the frequency and severity of drought due to climate change, understanding these relationships between drought and human health will better inform drought mitigation planning to reduce potential impacts.

Disadvantaged by More Than Distance: A Systematic Literature Review of Injury in Rural Australia

Rural populations experience injury-related mortality and morbidity rates 1.5 times greater than metropolitan residents. Motivated by a call for stronger epidemiological evidence around rural injuries to inform prevention, a systematic review of peer-reviewed literature published between January 2010 and March 2021 was undertaken to explore the epidemiology of rural injury and associated risk factors in Australia. A subsequent aim was to explore definitions of rurality used in injury prevention studies. There were 151 papers included in the review, utilizing 23 unique definitions to describe rurality. People living in rural areas were more likely to be injured, for injuries to be more severe, and for injuries to have greater resulting morbidity than people in metropolitan areas. The increase in severity reflects the mechanism of rural injury, with rural injury events more likely to involve a higher energy exchange. Risk-taking behavior and alcohol consumption were significant risk factors for rural injury, along with rural cluster demographics such as age, sex, high socio-economic disadvantage, and health-related comorbidities. As injury in rural populations is multifactorial and nonhomogeneous, a wide variety of evidence-based strategies are needed. This requires funding, political leadership for policy formation and development, and implementation of evidence-based prevention interventions.

The impact of cold spells on schizophrenia admissions and the synergistic effect with the air quality index

OBJECTIVES

Under current global climate conditions, there are insufficient studies on the health influences of cold spells, especially on mental health. This study aimed to examine the effect of cold spells on schizophrenia admissions and to analyze the potential interaction effect with the air quality index (AQI).

METHODS

Daily data on schizophrenia admissions and climatic variables in Hefei were collected from 2013 to 2019. Based on 20 definitions, the impacts of cold spells were quantified separately to find the most appropriate definition for the region, and meta-regression was used to explore the different effect sizes of the different days in a cold spell event. In addition, the potential interaction effect was tested by introducing a categorical variable, CSH, reflecting the cold spell and AQI level.

RESULTS

The cold spell defined by temperature below the 6th centile while lasting for at least three days produced the optimum model fit performance. In general, the risk of schizophrenia admissions increased on cold spell days. The largest single-day effect occurred on the 12th day with RR = 1.081 (95% CI: 1.044, 1.118). In a single cold spell event, the effect of the 3rd and subsequent days of a cold spell (RR = 1.082, 95% CI: 1.036, 1.130) was higher than that on the 2nd day (RR = 1.054, 95% CI: 1.024, 1.085). Similarly, the effect of the 2nd day was also higher than that of the 1st day (RR = 1.027, 95% CI: 1.012, 1.042). We found a synergistic effect between cold spells and high AQI in the male group, and the relative excess risk due to interaction (RERI) was 0.018 (95% CI: 0.005-0.030).

CONCLUSIONS

This study suggested that the impacts of cold spells should be considered based on the definition of the most appropriate for the region when formulating targeted measures of schizophrenia. The discovery of the synergistic effect was referred to help the selection of the timing of precautions for susceptible people.

Maasai women hearing voices: Implications for global mental health

There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.

Climate Change, Drought and Rural Suicide in New South Wales, Australia: Future Impact Scenario Projections to 2099

Mental health problems are associated with droughts, and suicide is one of the most tragic outcomes. We estimated the numbers of suicides attributable to drought under possible climate change scenarios for the future years until 2099, based on the historical baseline period 1970–2007. Drought and rural suicide data from the Australian state of New South Wales (NSW) were analyzed for the baseline data period. Three global climate models and two representative concentration pathways were used to assess the range of potential future outcomes. Drought-related suicides increased among rural men aged 10–29 and 30–49 yrs in all modelled climate change scenarios. Rural males aged over 50 yrs and young rural females (10–29) showed no increased suicide risk, whereas decreased suicide rates were predicted for rural women of 30–49 and 50-plus years of age, suggesting resilience (according to the baseline historical relationship in those population sub-groups). No association between suicide and drought was identified in urban populations in the baseline data. Australian droughts are expected to increase in duration and intensity as climate change progresses. Hence, estimates of impacts, such as increased rural suicide rates, can inform mitigation and adaptation strategies that will help prepare communities for the effects of climate change.

Climate change and mental health research methods, gaps, and priorities: a scoping review

Research on climate change and mental health is a new but rapidly growing field. To summarise key advances and gaps in the current state of climate change and mental health studies, we conducted a scoping review that comprehensively examined research methodologies using large-scale datasets. We identified 56 eligible articles published in Embase, PubMed, PsycInfo, and Web of Science between Jan 1, 2000, and Aug 9, 2020. The primary data collection method used was surveys, which focused on self-reported mental health effects due to acute and subacute climate events. Other approaches used administrative health records to study the effect of environmental temperature on hospital admissions for mental health conditions, and national vital statistics to assess the relationship between environmental temperature and suicide rates with regression analyses. Our work highlights the need to link population-based mental health outcome databases to weather data for causal inference. Collaborations between mental health providers and data scientists can guide the formation of clinically relevant research questions on climate change.

Climate rather than economic variables might have caused increase in US homicide but not suicide rates during the Great Depression

BACKGROUND

It is widely believed that during the Great Depression (1929-1933) there was a rise in suicidal rates which was causally related to the increase in unemployment. There are no studies on the effect the Great Depression had on homicidal rates METHODS: The data concerning suicide, homicide, economic and climatic variables for the years 1900-1940 for the whole of the US were gathered from the US Center for Disease Control, the Maddison Project, the National Bureau of Economic Research and the National Climatic Data Center. Time Series Analysis was performed.

RESULTS

The results are inconclusive on the role of economic factors but preclude any role of climate on suicidal rates during the years 1900-1940 in the US. Suicidal rates might have a 24-years periodicity, however much longer time series are needed to confirm this. On the contrary they strongly suggest an effect of higher temperatures on homicidal rates after 1922.

CONCLUSIONS

The results of the current study suggest a direct and clear effect of climate (higher temperatures) on the increasing homicidal rates in the US after 1922 but failed to establish a causal relationship between suicide rates and economic or climate variables. These should be considered together with increasing concerns on the possible effect of climate change on mental health.

Systematic review of quantitative studies assessing the relationship between environment and mental health in rural areas

OBJECTIVE

Physical and natural environments might strongly influence mental health and well-being. Many studies have examined this relationship in urban environments, with fewer focused on rural settings. The aim of this systematic review was to synthesise quantitative evidence for the relationship between environmental factors (drought, climate and extreme weather events, land use/environmental degradation, green space/vegetation, engagement in natural resource management activities) and mental health or well-being in rural areas.

DESIGN

Following a systematic search of three databases (PsycINFO, MEDLINE and Web of Science), 4368 articles were identified, of which 28 met eligibility criteria for inclusion in the review.

RESULTS

Poorer mental health and well-being was typically found to have an association with extreme climate or weather events and environmental degradation. The observed relationships were largely assessed at area-wide or community levels.

CONCLUSIONS

Studies examining the relationship between the environmental condition of land and mental health at an individual level, particularly within farms, are lacking. Addressing this gap in research requires interdisciplinary expertise and diverse methodology. Few studies examined the effects of natural resource management practices/principles or biodiversity on mental health. While there is evidence that extreme climate or weather events have a negative impact on mental health in rural areas, there remain considerable gaps in our knowledge of how rural environments influence mental health and well-being.

The Effects of Climate Change on Child and Adolescent Mental Health: Clinical Considerations

PURPOSE OF REVIEW

We review recent literature on the effects of climate change on child and adolescent mental health and discuss treatment and engagement by clinicians.

RECENT FINDINGS

Climate change affects child and adolescent mental health in many intersecting ways, including as a social and ecological determinant of health, a threat amplifier, and a source of trauma and distress. Single extreme weather events contribute to significant negative mental health consequences; however, subacute and chronic climate events also have mental health sequelae. Furthermore, awareness of the climate crisis is associated with emotional distress. Young people with pre-existing mental illness and lacking social support may be at elevated risk for climate change-related mental health effects. Climate activism is associated with resilience and positive development, but may also be a source of increased stress, particularly for marginalized youths. Climate change can affect the mental health of children and adolescents in complex and diverse ways. Sources of coping and resilience also vary greatly between individuals. Mental health clinicians must respond to this existential crisis by addressing research gaps in this area, obtaining relevant clinical training, educating their communities, and joining and supporting young people in their advocacy efforts.

The association between drought conditions and increased occupational psychosocial stress among U.S. farmers: An occupational cohort study

BACKGROUND

Drought represents a globally relevant natural disaster linked to adverse health. Evidence has shown agricultural communities to be particularly susceptible to drought, but there is a limited understanding of how drought may impact occupational stress in farmers.

METHODS

We used repeated measures data collected in the Musculoskeletal Symptoms among Agricultural Workers Cohort study, including 498 Midwestern U.S. farmers surveyed with a Job Content Questionnaire (JCQ) at six-month intervals in 312 counties from 2012 through 2015. A longitudinal linear mixed effects model was used to estimate the change in job strain ratio, a continuous metric of occupational psychosocial stress, during drought conditions measured with a 12-month standardized precipitation index. We further evaluated associations between drought and psychological job demand and job decision latitude, the job strain components, and applied a stratified analysis to evaluate differences by participant sex, age, and geography.

RESULTS

During the growing season, the job strain ratio increased by 0.031 (95% CI: 0.012, 0.05) during drought conditions, an amount equivalent to a one-half standard deviation change (Cohen's D = 0.5), compared to non-drought conditions. The association between drought and the job strain ratio was driven mostly by increases in the psychological job demand (2.09; 95% CI: 0.94, 3.24). No risk differences were observed by sex, age group, or geographic region.

CONCLUSIONS

Our results suggest a previously unidentified association between drought and increased occupational psychosocial stress among farmers. With North American climate anticipated to become hotter and drier, these findings could provide important health effects data for federal drought early warning systems and mitigation plans.

The Effects of Drought Severity and Its Aftereffects on Mortality in Bangladesh

Background

Drought has been a considerable problem for many years in northern Bangladesh. However, the health impacts of drought in this region are not well understood.

Methods

This study analyzed the impact of drought duration and severity on select causes of mortality in northern Bangladesh. Rainfall data from three meteorological stations (Rangpur, Dinajpur and Nilphamari) in northern Bangladesh were used to assess drought and non-drought periods, and the Standardized Precipitation Index was used to categorize mild, moderate, severe, and extreme drought. Mortality data from 2007 to 2017 for the three areas were collected from the Sample Vital Registration System, which is a survey of 1 million people. The generalized linear model with Poisson regression link was used to identify associations between mortality and the drought severity and 1-month preceding SPI.

Results

Only severe and extreme drought in the short-term drought periods affected mortality. Long-term drought was not associated with natural cause mortality in Rangpur and Nilphamari. In Dinajpur, mild and moderate drought was associated with circulatory- and respiratory-related mortality.

Conclusion

The impact of drought on mortality varied by region. This study improves our understanding of how droughts affect specific causes of mortality and will help policy makers to take appropriate measures against drought impacts on selected cause of mortality. Future research will be critical to reduce drought-related risks of health.

Health Impacts of Climate Change as Contained in Economic Models Estimating the Social Cost of Carbon Dioxide

The health impacts of climate change are substantial and represent a primary motivating factor to mitigate climate change. However, the health impacts in economic models that estimate the social cost of carbon dioxide (SC-CO2) have generally been made in isolation from health experts and have never been rigorously evaluated. Version 3.10 of the Framework for Uncertainty, Negotiation and Distribution (FUND) model was used to estimate the health-based portion of current SC-CO2 estimates across low-, middle-, and high-income regions. In addition to the base model, three additional experiments assessed the sensitivity of these estimates to changes in the socio-economic assumptions in the model. Economic impacts from adverse health outcomes represent ∼8.7% of current SC-CO2 estimates. The majority of these health impacts (74%) were attributable to diarrhea mortality (from both low- and high-income regions) followed by diarrhea morbidity (12%) and malaria mortality (11%); no other health impact makes a meaningful contribution to SC-CO2 estimates in current economic models. The results of the socio-economic experiments show that the health-based portion of SC-CO2 estimates are highly sensitive to assumptions regarding income elasticity of health effects, income growth, and use of equity weights. Improving the health-based portion of SC-CO2 estimates could have substantial impacts on magnitude of the SC-CO2. Incorporating additional health impacts not previously included in estimates of SC-CO2 will be a critical component of model updates. This effort will be most successful through coordination between economists and health researchers and should focus on updating the form and function of concentration-response functions.

Crisis care: tackling the climate and ecological emergency

The climate crisis is a health crisis; it demands the urgent attention and action of healthcare professionals and organisations. In this issue of the BJPsych Bulletin, we consider what the destructive effects of the climate and ecological crisis entail for the mental health of populations, and what the response of psychiatrists, both individual and collective, must be. We also highlight the opportunities and benefits a more sustainable and preventative approach could offer individuals, communities and the planet.

Factors Associated with Suicidal Behavior in Farmers: A Systematic Review

This review aimed to investigate the factors associated with suicidal behavior in farmers in the scientific literature. Two researchers participated independently in searching databases, specifically PubMed/MEDLINE, LILACS, Web of Science, Scopus, PsycINFO, and SciELO. Only observational studies were included. The quality of the selected studies was assessed with a critical assessment checklist for cross-sectional analytical and case-control studies, prepared by the Joanna Briggs Institute. Data related to the publication were collected (author and year; city/country); methodological design; sample/population (gender; average age), outcome, measuring instrument and factors associated with suicidal behavior. A total of 14 studies were included in the systematic review, and factors associated with farmers' behavior in mental health (depression), seasonal impacts (drought), and work exposures (herbicides and insecticides) were identified. However, heterogeneity was found in terms of the method, measurement of suicidal behavior, and associated factors, which indicates the need for further studies.

Modelling the Relationship between Rainfall and Mental Health Using Different Spatial and Temporal Units

Drought is thought to impact upon the mental health of agricultural communities, but studies of this relationship have reported inconsistent results. A source of inconsistency could be the aggregation of data by a single spatiotemporal unit of analysis, which induces the modifiable areal and temporal unit problems. To investigate this, mental health-related emergency department (MHED) presentations among residents of the Wheat Belt region of Western Australia, between 2002 and 2017, were examined. Average daily rainfall was used as a measure of drought. Associations between MHED presentations and rainfall were estimated based on various spatial aggregations of underlying data, at multiple temporal windows. Wide variation amongst results was observed. Despite this, two key features were found: Associations between MHED presentations and rainfall were generally positive when rainfall was measured in summer months (rate ratios up to 1.05 per 0.5 mm of daily rainfall) and generally negative when rainfall was measured in winter months (rate ratios as low as 0.96 per 0.5 mm of daily rainfall). These results demonstrate that the association between drought and mental health is quantifiable; however, the effect size is small and varies depending on the spatial and temporal arrangement of the underlying data. To improve understanding of this association, more studies should be undertaken with longer time spans and examining specific mental health outcomes, using a wide variety of spatiotemporal units.

Drought effects on specific-cause mortality in Lisbon from 1983 to 2016: Risks assessment by gender and age groups

Portugal (Southwestern Europe) experiences a high incidence of dry hazards such as drought, a phenomenon that entails a notable burden of morbidity and mortality worldwide. For the first time in the Lisbon district, a time-series study was conducted to evaluate the impact of drought measured by the Standardised Precipitation Index (SPI) and Standardised Precipitation-Evapotranspiration Index (SPEI) on the daily natural, circulatory, and respiratory mortality from 1983 to 2016. An assessment by gender and adult age population groups (45-64, 65-74, ≥75 years old) was included. To estimate the relative risks and attributable risks, generalised linear models with a Poisson link were used. Additionally, the influence of heatwaves and atmospheric pollution for the period from 2007 to 2016 (available period for pollution data) was considered. The main findings indicate statistically significant associations between drought conditions and all analysed causes of mortality. Moreover, SPEI shows an improved capability to reflect the different risks. People in the 45-64 year-old group did not indicate any significant influence in any of the cases, whereas the oldest groups had the highest risk. The drought effects on mortality among the population varied across the different study periods, and in general, the men population was affected more than the women population (except for the SPEI and circulatory mortality during the long study period). The short-term influence of droughts on mortality could be explained primarily by the effect of heatwaves and pollution; however, when both gender and age were considered in the Poisson models, the effect of drought also remained statistically significant when all climatic phenomena were included for specific groups of the total population and men. This type of study facilitates a better understanding of the population at risk and allows the development of more effective measures to mitigate the drought effects on the population.

New Insights Into the Relationship Between Drought and Mental Health Emerging From the Australian Rural Mental Health Study

While it is recognized that drought affects mental health, few population-based longitudinal studies quantify this relationship. In this study, we investigate the effects of drought on mental health in a rural population, and how these effects change with continued exposure to drought conditions. Using a panel dataset consisting of 6,519 observations from the Australian Rural Mental Health Study, we found a non-linear (inverted U-shape) relationship between drought exposure and mental health. Specifically, people experienced an increase of psychological distress for the first 2.5-3 years of drought, after which time this distress dissipates. These effects were maintained after controlling for demographic, social, and environmental factors. We also found that while psychological distress decreases in the later stages of drought, this does not necessarily mean people have good mental health because, for example, factors such as life satisfaction decreased as drought persisted. This is important as it highlights the need for sustained support to mitigate the long-term effects of drought on mental health that persist after the drought has apparently finished.

When Land Is Under Pressure Health Is Under Stress

The land provides vital resources to support life on Earth. Land ecosystems services have social, cultural, and spiritual benefits and promote human health and well-being. However, human activities, particularly ongoing unsustainable land practices, are negatively impacting ecosystems through desertification, land degradation and drought (DLDD). This article highlights the pressures and impacts of DLDD on human health through exposure pathways, including water security and safety; sanitation and hygiene; food security and safety; air quality; and soil quality. We describe the impacts on 19 health outcomes in three groups: non-communicable diseases; injuries; and infections, parasitic and nutritional diseases. The magnitude of these health impacts is mediated by social, economic, and health system-related factors. We propose actions for the health sector to respond to the DLDD challenges.

Anxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique

In the past two decades, climate change-related natural disasters, such as hurricanes, floods, and droughts have become increasingly frequent and severe, impacting the emotional and psychological well-being of those who are directly or indirectly exposed to them. Despite great interest in understanding differences in anxiety and resilience in response to natural disasters, enthusiasm appears to outstrip empirical clarity, as there remains considerable ambiguity as to determinants of resilient or pathological outcomes following exposure to natural disasters. In addition, there are several major methodological limitations in climate change and related natural disaster research, including the use of univariate analyses, cross-sectional design, and retrospective measures. Keeping these limitations in mind, we first review literature examining the mental health outcomes of natural disasters. Findings suggest that, overall, resilience is more common than pathological outcomes. Second, we use a multi-dimensional framework of resilience to selectively review factors at the event, individual, as well as family and community levels that could help inform resilient or pathological outcomes. Finally, we consider key limitations and future directions for research and practice in the field of anxiety and resilience in response to climate disasters.

Strategies for Delivering Mental Health Services in Response to Global Climate Change: A Narrative Review

This narrative review examined strategies for preparedness and response to mental health impacts of three forms of climate change from a services perspective: (1) acute and extreme weather events such as hurricanes, floods, and wildfires, (2) sub-acute or long-term events such as droughts and heatwaves; and (3) the prospect of long-term and permanent changes, including higher temperatures, rising sea levels, and an uninhabitable physical environment. Strategies for acute events included development and implementation of programs and practices for monitoring and treating mental health problems and strengthening individual and community resilience, training of community health workers to deliver services, and conducting inventories of available resources and assessments of at-risk populations. Additional strategies for sub-acute changes included advocacy for mitigation policies and programs and adaptation of guidelines and interventions to address the secondary impacts of sub-acute events, such as threats to livelihood, health and well-being, population displacement, environmental degradation, and civil conflict. Strategies for long-lasting changes included the implementation of evidence-based risk communication interventions that address the existing and potential threat of climate change, promoting the mental health benefits of environmental conservation, and promoting psychological growth and resilience.

Extremes in water availability and suicide: Evidence from a nationally representative sample of rural Indian adults

BACKGROUND

Extremes in water availability, either exceptionally wet or dry conditions, can damage crops and may detrimentally affect the livelihood and well-being of people engaged in agriculture. We estimated the effect of water availability on suicide in rural India, a context where the majority of households are dependent upon agriculture.

METHODS

We used data from a nationally representative sample of 8.5 million people who were monitored for causes of death from 2001 to 2013. Water availability was measured with high-resolution precipitation and temperature data (i.e., the Standardized Precipitation Evapotranspiration Index). We used a fixed effects approach that modeled changes in water availability within districts (n = 569) over time (n = 13 years) to estimate the impact on suicide deaths. We restricted our analysis to rural areas and to deaths occurring during the growing season (June-March) among adults aged 15 or older, and controlled for sex, age, region, and year. We used Poisson regression with standard errors clustered at the district level and total deaths as the offset.

RESULTS

There were 9456 suicides and 249,786 total deaths in our study population between 2001 and 2013. Compared to normal growing seasons, the percent of deaths due to suicide increased by 18.7% during extremely wet growing seasons (95% CI: 6.2, 31.2) and by 3.6% during extremely dry growing seasons (95% CI: -17.9, 25.0). We found that effects varied by age.

CONCLUSIONS

We found extremes is water availability associated with an increase in suicide. Abnormally wet growing conditions may play an important, yet overlooked, role in suicide among rural Indian adults.

Nonlinear temperature-suicide association in Japan from 1972 to 2015: Its heterogeneity and the role of climate, demographic, and socioeconomic factors

It has been reported that suicide is associated with ambient temperature; however, the heterogeneity in this association and its underlying factors have not been extensively investigated. Therefore, we investigated the spatial and temporal variation in the temperature-suicide association and examined climatic, demographic, and socioeconomic factors that may underlie such heterogeneity. We analyzed the daily time-series data for the suicide counts and ambient temperature, which were collected for the 47 prefectures of Japan from 1972 to 2015, using a two-stage analysis. In the first stage, the prefecture-specific temperature-suicide association was estimated by using a generalized linear model. In the second stage, the prefecture-specific associations were pooled, and key factors explaining the spatial and temporal variation were identified by using mixed effects meta-regression. Results showed that there is an inverted J-shape nonlinear association between temperature and suicide; the suicide risk increased with temperature but leveled off above 24.4 °C. The nationwide relative risk (RR) for the maximum suicide temperature versus 5th temperature percentile (2.9 °C) was estimated as 1.26 (95% CI: 1.22, 1.29). The RRs were larger for females than for males (1.32 vs. 1.22) and larger for elderly people (≥65 y) than for the non-elderly (15-64 y) (1.51 vs. 1.18). The RRs were larger for rural prefectures, which are characterized by smaller population, higher proportions of females and elderly people, and lower levels of financial capability and the proportion of highly educated people. The RRs were also larger in colder and less humid prefectures. These findings may help in understanding the potential mechanism of the temperature-suicide association and projecting the future risk of suicide under climate change.

Water and mental health

There is a well‐established connection among water quality, sanitation, and physical health. The potentially important relationship between water and mental health is considerably less studied. Reviewing evidence from ethnography, geography, folklore, indigenous studies, rural medicine, drought research, and large‐n statistical studies, we argue there is now good theoretical rationale and growing evidence of water insecurity as a possible driver of mental ill‐health. Furthermore, some nascent evidence suggests that emotionally meaningful interactions with water might improve mental health outcomes. Leveraging these literatures, we address the many ways in which mental health outcomes are conceptualized and operationalized in water research, including as emotional distress, perceived stress, depressive symptoms, anxiety symptoms, somatic symptoms, and quality of life. We outline arguments supporting seven possible (and likely interlocking) mechanisms that could explain such a relationship: (a) material deprivation and related uncertainty, (b) shame of social failure, (c) worry about health threats, (d) loss of connections to people and places, (e) frustration around opportunity losses and restricted autonomy, (f) interpersonal conflict and intimate partner violence, and (g) institutional injustice or unfairness. However, we explain that as most existing studies are ethnographic, qualitative, or cross‐sectional, a causal relationship between water and mental ill‐health is yet to be confirmed empirically. More research on this topic is needed, particularly given that poorly understood connections may create barriers to achieving Sustainable Development Goals 3 (health) and 6 (water). We further suggest that tracking mental health indicators may provide unique and as‐yet underappreciated insights into the efficacy of water projects and other development interventions.

This article is categorized under:

Climate Change and Risk of Completed Suicide

Climate change is increasingly recognized as having multiple adverse mental health effects, many of which are just beginning to be understood. The elevated rates of suicides observed in some communities affected by climate change and rising rates of suicide in the United States as climate change intensifies have suggested the two may be associated. We searched PubMed and PsycInfo using the terms climate change and suicide, and provide here a review of the current literature on climate change and suicide that explores possible associations and methodological issues and challenges in this research.

Drought severity and all-cause mortality rates among adults in the United States: 1968-2014

BACKGROUND

Little is known about the effect of drought on all-cause mortality, especially in higher income countries such as the United States. As the frequency and severity of droughts are likely to increase, understanding the connections between drought and mortality becomes increasingly important.

METHODS

Our exposure variable was an annual cumulative drought severity score based on the 1-month, county-level Standardized Precipitation Evapotranspiration Index. The outcome variables of demographic subgroup-specific all-cause mortality count data per year were obtained from the National Vital Statistics System. Any counts below 10 deaths were censored in that demographic group per county. We modeled county-stratum-year mortality using interval-censored negative binomial regression with county-level random intercepts, for each combined age-race-sex stratum either with or without further stratification by climate regions. Fixed effects meta-regression was used to test the associations between age, race, sex, and region with the drought-mortality regression coefficients. Predictive margins were then calculated from the meta-regression model to estimate larger subgroup (e.g., 'race' or 'sex') associations of drought with mortality.

RESULTS

Most of the results were null for associations between drought severity and mortality, across joint strata of race, age, sex and region, but incidence rate ratios (IRRs) for 17 subgroups were significant after accounting for the multiple testing; ten were < 1 indicating a possible protective effect of drought on mortality for that particular subpopulation. The meta-regression indicated heterogeneity in the association of drought with mortality according to race, climate region, and age, but not by sex. Marginal means of the estimated log-incidence rate ratios differed significantly from zero for age groups 25-34, 35-44, 45-54 and 55-64; for the white race group; and for the South, West and Southwest regions, in the analysis that included wet county-years. The margin of the meta-regression model suggested a slightly negative, but not statistically significant, association of drought with same-year mortality in the overall population.

CONCLUSIONS

There were significant, heterogeneous-direction associations in subpopulation-stratified models, after controlling for multiple comparisons, suggesting that the impacts of drought on mortality may not be monolithic across the United States. Meta-regression identified systematic differences in the associations of drought severity with all-cause mortality according to climate region, race, and age. These findings suggest there may be important contextual differences in the effects of drought severity on mortality, motivating further work focused on local mechanisms. We speculate that some of the estimated negative associations of drought severity with same-year mortality could be consistent with either a protective effect of drought on total mortality in the same year, or with a delayed health effect of drought beyond the same year. Further research is needed to clarify associations of drought with more specific causes of death and with sublethal health outcomes, for specific subpopulations, and considering lagged effects occurring beyond the same year as the drought.