Heatwaves and their impact on people with alcohol, drug and mental health conditions: a discussion paper on clinical practice considerations

Views of Psychiatrists and Psychiatry Trainees on Climate Change: Distress, Training Needs, and Envisioned Role

OBJECTIVE

Increasing evidence demonstrates that climate change has effects on mental health. Given the magnitude of climate change's health consequences, mitigation and adaptation will require massive societal changes and the involvement of individuals and professional organizations. The aim of this research was to assess the views of psychiatrists and psychiatrists-in-training about climate change and its effects on health, perceived barriers to discussing climate change in their clinical, teaching, research, and advocacy work, personal preparedness for climate action, and expected roles of their professional organizations.

METHODS

The authors administered an online anonymous survey to members of two mid-Atlantic professional psychiatric organizations. Measures included an adaptation of The International Climate and Health Survey and demographic and career characteristics. Descriptive statistics for categorical variables were conducted.

RESULTS

The majority of the 67 participants who completed the survey were White and senior in their career, and almost all were clinicians. Most were concerned about climate change and its mental health effects on patients and supported their organizations' engagement in activities related to this topic. Barriers to engagement in climate change action included lack of time and believing it would not make a difference.

CONCLUSIONS

These findings demonstrate a desire of psychiatrists involved in teaching, research, and clinical work to address climate change and a need for training. These findings highlight the need for preparedness as newer generations face more disasters related to climate change, and experience psychological distress related to climate change.

Private vs. public emergency visits for mental health due to heat: An indirect socioeconomic assessment of heat vulnerability and healthcare access, in Curitiba, Brazil

Few studies have explored the influence of socioeconomic status (SES) on the heat vulnerability of mental health (MH) patients. As individual socioeconomic data was unavailable, we aimed to fill this gap by using the healthcare system type as a proxy for SES. Brazilian national statistics indicate that public patients have lower SES than private. Therefore, we compared the risk of emergency department visits (EDVs) for MH between patients from both healthcare types. EDVs for MH disorders from all nine public (101,452 visits) and one large private facility (154,954) in Curitiba were assessed (2017-2021). Daily mean temperature was gathered and weighed from 3 stations. Distributed-lag non-linear model with quasi-Poisson (maximum 10-lags) was used to assess the risk. We stratified by private and public, age, and gender under moderate and extreme heat. Additionally, we calculated the attributable fraction (AF), which translates individual risks into population-representative burdens - especially useful for public policies. Random-effects meta-regression pooled the risk estimates between healthcare systems. Public patients showed significant risks immediately as temperatures started to increase. Their cumulative relative risk (RR) of MH-EDV was 7.5 % higher than the private patients (Q-Test 26.2 %) under moderate heat, suggesting their particular heat vulnerability. Differently, private patients showed significant risks only under extreme heat, when their RR became 4.3 % higher than public (Q-Test 6.2 %). These findings suggest that private patients have a relatively greater adaptation capacity to heat. However, when faced with extreme heat, their current adaptation means were potentially insufficient, so they needed and could access healthcare freely, unlike their public counterparts. MH patients would benefit from measures to reduce heat vulnerability and access barriers, increasing equity between the healthcare systems in Brazil. AF of EDVs due to extreme heat was 0.33 % (95%CI 0.16;0.50) for the total sample (859 EDVs). This corroborates that such broad population-level policies are urgently needed as climate change progresses.

Exploring the Nexus of Climate Change and Substance Abuse: A Scoping Review

INTRODUCTION

The increase in average air temperature and multiple extreme weather events, such as heatwaves and droughts, pose significant health risks to humans. This scoping review aims to examine the current state of the existing literature concerning the potential relationship between substance abuse and climate change, along with the aspects it encompasses.

MATERIAL AND METHODS

The review followed PRISMA guidelines for methodological rigor, aiming to identify studies on drug abuse. Searches were conducted across the primary databases using specific search strings. Quality assessment involved evaluating the research question's clarity, search strategy transparency, consistency in applying the inclusion/exclusion criteria, and reliability of data extraction.

RESULTS

Most studies were conducted in the USA. They included observational and retrospective quantitative studies, as well as qualitative and prospective observational ones. Research examined the correlation between extreme weather and some substance abuse. All studies analyzed the adverse effects of climate change, especially heatwaves, on both physiological and pathological levels.

CONCLUSIONS

The scoping review notes the scarcity of studies about the correlation between substance abuse and climate change, and emphasizes the threats faced by individuals with substance abuse and mental health disorders due to climate change.

Impact of heat on mental health emergency visits: a time series study from all public emergency centres, in Curitiba, Brazil

OBJECTIVES

Quantify the risk of mental health (MH)-related emergency department visits (EDVs) due to heat, in the city of Curitiba, Brazil.

DESIGN

Daily time series analysis, using quasi-Poisson combined with distributed lag non-linear model on EDV for MH disorders, from 2017 to 2021.

SETTING

All nine emergency centres from the public health system, in Curitiba.

PARTICIPANTS

101 452 EDVs for MH disorders and suicide attempts over 5 years, from patients residing inside the territory of Curitiba.

MAIN OUTCOME MEASURE

Relative risk of EDV (RREDV) due to extreme mean temperature (24.5°C, 99th percentile) relative to the median (18.02°C), controlling for long-term trends, air pollution and humidity, and measuring effects delayed up to 10 days.

RESULTS

Extreme heat was associated with higher single-lag EDV risk of RREDV 1.03(95% CI 1.01 to 1.05-single-lag 2), and cumulatively of RREDV 1.15 (95% CI 1.05 to 1.26-lag-cumulative 0-6). Strong risk was observed for patients with suicide attempts (RREDV 1.85, 95% CI 1.08 to 3.16) and neurotic disorders (RREDV 1.18, 95% CI 1.06 to 1.31). As to demographic subgroups, females (RREDV 1.20, 95% CI 1.08 to 1.34) and patients aged 18-64 (RREDV 1.18, 95% CI 1.07 to 1.30) were significantly endangered. Extreme heat resulted in lower risks of EDV for patients with organic disorders (RREDV 0.60, 95% CI 0.40 to 0.89), personality disorders (RREDV 0.48, 95% CI 0.26 to 0.91) and MH in general in the elderly ≥65 (RREDV 0.77, 95% CI 0.60 to 0.98). We found no significant RREDV among males and patients aged 0-17.

CONCLUSION

The risk of MH-related EDV due to heat is elevated for the entire study population, but very differentiated by subgroups. This opens avenue for adaptation policies in healthcare: such as monitoring populations at risk and establishing an early warning systems to prevent exacerbation of MH episodes and to reduce suicide attempts. Further studies are welcome, why the reported risk differences occur and what, if any, role healthcare seeking barriers might play.

Climate Change and the Opioid Epidemic

ABSTRACT

Ongoing assessments by climate scientists, including a recent report from the United Nations' Intergovernmental Panel on Climate Change, punctuate the pronounced effect that climate change is poised to have in the near future on the health and well-being of humans-particularly those with low socioeconomic status-throughout the world. To this end, to date, very limited scholarly attention has been placed on the effects that climate change may have on people who use drugs (PWUDs), in particular those with opioid use disorder, and assessed their structural and social determinants of climate change vulnerability. Since COVID-19, which has key lessons to offer on climate change's potential effects on PWUDs, the opioid epidemic has been rapidly accelerating in terms of its socioeconomic, racial, and geographic reach. The opioid epidemic has been further deepened by increasing fentanyl contamination and co-use with stimulants such as methamphetamine and (crack) cocaine, spurring a heavy increase in overdose deaths. These trends highlight a looming confrontation between the world's complex overdose crisis and its equally intensifying climate emergency. This piece contextualizes the specter of harms that climate change is likely to cultivate against PWUDs and offers strategies for mitigation.

Climate-sensitive health counselling: a scoping review and conceptual framework

Health professional societies and researchers call for the integration of climate change into health counselling. However, the scientific evidence and conceptual grounding of such climate-sensitive health counselling (CSHC) remains unclear. We conducted a scoping review identifying scientific articles on the integration of climate change into communication between health professionals and patients in health-care settings. Scientific databases (Web of Science, PubMed, and Google Scholar) were searched from inception until Nov 30, 2022. 97 articles were included, of which 33 represented empirical research, and only two evaluated the effects of CSHC. More than half of the articles originated from the USA and addressed physicians. We introduce a conceptual framework for CSHC, which elaborates on aims, content areas, and communication strategies, and establishes the guiding principle of integrating CSHC into routine activities of health care. This framework supports health professionals in implementing CSHC and enables researchers to conceptualise intervention studies investigating how CSHC can contribute to the health of patients and the planet.

Temperature and mental health-related emergency department and hospital encounters among children, adolescents and young adults

AIMS

We examine the association between high ambient temperature and acute mental health-related healthcare encounters in New York City for children, adolescents and young adults.

METHODS

This case-crossover study included emergency department (ED) visits and hospital encounters with a primary diagnosis of any mental health disorder during warm-season months (June-August) in New York City from 2005 to 2011 from patients of three age groups (6-11, 12-17 and 18-25 years). Using a distributed lag non-linear model over 0-5 lag days, by fitting a conditional logistic regression for each age group, we calculated the cumulative odds ratios of mental health encounters associated with an elevated temperature. Analyses were stratified by race/ethnicity, payment source and mental health categories to elucidate vulnerable subpopulations.

RESULTS

In New York City, there were 82,982 mental health-related encounters for young people aged 6 to 25 years during our study period months. Elevated temperature days were associated with higher risk of mental health-related ED and hospital encounters for the 6- to 11-year-olds (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.13-1.46), for the 12- to 17-year-olds (OR: 1.17, 95% CI: 1.09-1.25) and for the 18- to 25-year-olds (OR: 1.09, 95% CI: 1.04-1.15). Children with reaction disorders, adolescents with anxiety and bipolar disorders, young adults with psychosis and reaction disorders and Black and non-Hispanic children and adolescents showed vulnerability to elevated temperature.

CONCLUSIONS

We found that elevated ambient temperatures were associated with acute mental health ED or hospital encounters across childhood, adolescence and young adulthood.

An epidemiological study of mental health problems related to climate change: A procedural framework for mental health system workers

BACKGROUND

The Arab region has witnessed different biological hazards, including cholera, yellow fever, and the COVID-19 pandemic. In addition, changes in rainfall and increased vegetation cover led to locust outbreaks in Tunisia, Libya, Morocco, and Saudi Arabia. This problem still exists and affects more than 20 countries and concerns indicate food shortages and food insecurity for more than 20 million people.

OBJECTIVE

This study aimed to detect mental health problems related to climate change in the Arab world.

METHODS

A cross-sectional descriptive survey was applied to determine the prevalence of mental health problems related to climate change (MHPCC). A random sample consisted of 1080 participants (523 male and 557 female), residents in 18 Arab countries; their ages ranged from 25 to 60 years. The Mental Health Problems related to Climate Change Questionnaire (MHPCCQ) was completed online.

RESULTS

The results indicated average levels of MHPCC prevalence. The results also revealed no significant statistical differences in the MHPCC due to gender, educational class, and marital status except in climate anxiety; there were statistical differences in favor of married subgroup individuals. At the same time, there are statistically significant differences in the MHPCC due to the residing country variable in favor of Syria, Yemen, Algeria, Libya, and Oman regarding fears, anxiety, alienation, and somatic symptoms. In addition, Tunisia, Bahrain, Sudan, and Iraq were higher in climate depression than the other countries.

CONCLUSION

The findings shed light on the prevalence of MHPCC in the Arab world and oblige mental health system workers, including policymakers, mental health providers, and departments of psychology in Arab universities, to take urgent action to assess and develop the system for mental health to manage the risks of extreme climate change on the human mental health.

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.

Interaction of maternal medication use with ambient heat exposure on congenital heart defects in the National Birth Defects Prevention Study

BACKGROUND

Maternal exposure to weather-related extreme heat events (EHEs) has been associated with congenital heart defects (CHDs) in offspring. Certain medications may affect an individual's physiologic responses to EHEs. We evaluated whether thermoregulation-related medications modified associations between maternal EHE exposure and CHDs.

METHODS

We linked geocoded residence data from the U.S. National Birth Defects Prevention Study, a population-based case-control study, to summertime EHE exposures. An EHE was defined using the 90th percentile of daily maximum temperature (EHE90) for each of six climate regions during postconceptional weeks 3-8. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for associations between EHE90 and the risk of CHDs were estimated by strata of maternal thermoregulation-related medication use and climate region. Interaction effects were evaluated on multiplicative and additive scales.

RESULTS

Over 45% of participants reported thermoregulation-related medication use during the critical period of cardiogenesis. Overall, these medications did not significantly modify the association between EHEs and CHDs. Still, medications that alter central thermoregulation increased aORs (95% CI) of EHE90 from 0.73 (0.41, 1.30) among non-users to 5.09 (1.20, 21.67) among users in the Southwest region, U.S. This effect modification was statistically significant on the multiplicative (P = 0.03) and additive scales, with an interaction contrast ratio (95% CI) of 1.64 (0.26, 3.02).

CONCLUSION

No significant interaction was found for the maternal use of thermoregulation-related medications with EHEs on CHDs in general, while medications altering central thermoregulation significantly modified the association between EHEs and CHDs in Southwest U.S. This finding deserves further research.

Main and added effects of heatwaves on hospitalizations for mental and behavioral disorders in a tropical megacity of Vietnam

Vietnam is highly vulnerable to climate change-related extreme weather events such as heatwaves. This study assesses the association between heatwaves and hospitalizations due to mental and behavioral disorders (MBDs) in Ho Chi Minh City (HCMC). We collected daily MBD hospital admissions data at the HCMC Mental Health Hospital from 2017 to 2019. Heatwaves effects were characterized into the main effect (i.e., the intensity of temperature during heatwaves) and the added effect (i.e., the duration of heatwaves). Time series Poisson regression coupled with a distributed lag linear model (DLM) was used to quantify the 14-day lags effect of heatwaves. Confounders including long-term trend, seasonality, days of the week, holidays, and relative humidity were included in the model. Heatwaves increased all-cause MBD hospitalization by 62% (95%Cl, 36-93%) for the main effect and by 8% (95% Cl, - 3% to 19%) for the added effect. Noticeably, the group aged 18-60 years old was affected by the main effect of the heatwave, while the group aged 61 years and older was affected by the added effect of the heatwave. The effects of heatwaves differed among groups of MBD hospitalizations. The mental and behavioral disorder group due to psychoactive substance use was significantly affected by the main effect of heatwaves (RR:2.21; 95%Cl:1.55-3.15). The group of schizophrenia, schizotypal and delusional disorders were highly vulnerable towards both the main and the added effect of heatwaves with RR = 1.50 (95%CI, 1.20-1.86) and RR = 1.14 (95%CI, 1.01-1.30), respectively.

Racial Disparities in Climate Change-Related Health Effects in the United States

PURPOSE OF REVIEW

Climate change is causing warming over most parts of the USA and more extreme weather events. The health impacts of these changes are not experienced equally. We synthesize the recent evidence that climatic changes linked to global warming are having a disparate impact on the health of people of color, including children.

RECENT FINDINGS

Multiple studies of heat, extreme cold, hurricanes, flooding, and wildfires find evidence that people of color, including Black, Latinx, Native American, Pacific Islander, and Asian communities are at higher risk of climate-related health impacts than Whites, although this is not always the case. Studies of adults have found evidence of racial disparities related to climatic changes with respect to mortality, respiratory and cardiovascular disease, mental health, and heat-related illness. Children are particularly vulnerable to the health impacts of climate change, and infants and children of color have experienced adverse perinatal outcomes, occupational heat stress, and increases in emergency department visits associated with extreme weather. The evidence strongly suggests climate change is an environmental injustice that is likely to exacerbate existing racial disparities across a broad range of health outcomes.

Risk factors for hyperthermia mortality among emergency department patients

PURPOSE

This study examines risk factors for heat-related mortality due to hyperthermia in emergency department patients, a vulnerable population.

METHODS

This matched case-control study used statewide, longitudinally linked emergency department (ED) data and death records from California. Cases comprised California residents (≥18 years) who presented to a state-licensed ED and died of hyperthermia during the study period (2009-2012). For each case, up to five ED patients were randomly selected as live controls and matched on sex and age. Patients' demographic characteristics and history of ED utilization for alcohol use, drug use, psychiatric disorders, heart-related conditions, chronic respiratory disease, neurodegenerative disorders, and cerebrovascular disease were assessed in relationship to hyperthermia mortality.

RESULTS

Using multivariate conditional logistic regression models, hyperthermia mortality cases had higher odds of prior ED utilization for alcohol use (OR = 11.16, 95% CI = 3.87, 32.17) compared to controls. Cases were also more likely than controls to have Medicare insurance (OR = 5.80, 95% CI = 1.70, 15.15) or self-pay (OR = 5.39, 95% CI = 1.73, 16.79), at their most recent ED visit.

CONCLUSIONS

ED patients presenting with alcohol problems may face increased risk of hyperthermia mortality. To help reduce heat-related mortality, EDs should consider interventions that target patients vulnerable to heat exposure.

Climate Change and Children’s Mental Health: A Developmental Perspective

Climate change is a major global public-health challenge that will have wide-ranging impacts on human psychological health and well-being. Children and adolescents are at particular risk because of their rapidly developing brain, vulnerability to disease, and limited capacity to avoid or adapt to threats and impacts. They are also more likely to worry about climate change than any other age group. Drawing on a developmental life-course perspective, we show that climate-change-related threats can additively, interactively, and cumulatively increase psychopathology risk from conception onward; that these effects are already occurring; and that they constitute an important threat to healthy human development worldwide. We then argue that monitoring, measuring, and mitigating these risks is a matter of social justice and a crucial long-term investment in developmental and mental health sciences. We conclude with a discussion of conceptual and measurement challenges and outline research priorities going forward.

Relationship between ambient temperature and severe acute poisoning by alcohol and drugs

AIM

To test the hypothesis that severe acute poisoning by alcohol and drugs is more frequent at higher rather than at lower ambient temperatures.

METHOD

This was a prospective observational study performed in a prehospital setting under marine west coast climate conditions. Data from the Emergency Medical Service in Hamburg (Germany) and data from the local weather station were evaluated over a 5-year period. Temperature data were obtained and matched with the associated rescue mission data, which were divided into the following groups: 1) alcohol poisoning, 2) opioid poisoning, 3) poisoning by sedatives/hypnotics, multiple drugs, volatile solvents, and other psychoactive substances. Lowess-Regression analysis was performed to assess the relationship between ambient temperature and frequency of severe acute poisoning. Additionally, three temperature ranges were defined in order to compare them with each other with regard to frequency of severe poisoning (<10 °C vs. 10-20 °C vs. >20 °C). The severity of emergencies was assessed using the National Advisory Committee for Aeronautics (NACA) scoring system.

RESULTS

In 1535 patients, severe acute alcohol or drug poisoning associated with loss of consciousness, hypotension, and impaired respiratory function was treated (alcohol: n = 604; opioids: n = 295; sedatives/hypnotics/multiple drugs: n = 636). Compared to mild temperatures (10-20 °C), the frequency of poisoning increased in all three groups at higher temperatures and decreased at lower temperatures (p < 0.01). No significant correlation was found between severity of emergencies and temperature.

CONCLUSIONS

Our results suggest a continuously increasing probability of occurrence of severe acute poisoning by alcohol and drugs with rising temperature.

Temperature and place associations with Inuit mental health in the context of climate change

BACKGROUND

Climate change has important implications for mental health globally. Yet, few studies have quantified the magnitude and direction of associations between weather and mental health-related factors, or assessed the geographical distribution of associations, particularly in areas experiencing rapid climatic change. This study examined the associations between air temperature variables and mental health-related community clinic visits across Nunatsiavut, Labrador, Canada, and the place-specific attributes of these associations.

METHODS

Daily de-identified community clinic visit data were collected from the provincial electronic health recording system and linked to historical weather data (2012-2018). A multilevel, multivariable negative binomial regression model was fit to investigate associations between temperature variables and mental health-related community clinic visits across the region, adjusting for seasonality as a fixed effect and community as a random effect. A multivariable negative binomial model was then fit for each Nunatsiavut community, adjusting for seasonality.

RESULTS

Mental health-related visits contributed to 2.4% of all 228,104 visit types across the study period; this proportion ranged from 0.6% to 11.3% based on community and year. Regionally, the incidence rate of mental health-related community clinic visits was greater after two weeks of warm average (i.e. above -5ᵒC) temperatures compared to temperatures below -5ᵒC (IRR_-5≤5ᵒC = 1.47, 95% CI = 1.21-1.78; IRR_6≤15ᵒC = 2.24, 95% CI = 1.66-3.03; IRR_>15ᵒC = 1.73, 95% CI = 1.02-2.94), and the incidence rate of mental health-related clinic visits was lower when the number of consecutive days within -5 to 5ᵒC ranges (i.e. temperatures considered to be critical to land use) increased (IRR = 0.96; 95% CI = 0.94-0.99), adjusting for seasonal and community effects. Community-specific models, however, revealed that no two communities had the same association between meteorological conditions and the incidence rate of daily mental health-related visits.

DISCUSSION

Regionally, longer periods of warm temperatures may burden existing healthcare resources and shorter periods of temperatures critical to land use (i.e. -5 to 5ᵒC) may present enjoyable or opportunistic conditions to access community and land-based resources. The heterogeneity found in temperature and mental health-related clinic visits associations across Nunatsiavut communities demonstrates that place quantitatively matters in the context of Inuit mental health and climate change. This evidence underscores the importance of place-based approaches to health policy, planning, adaptation, and research related to climate change, particularly in circumpolar regions such as Nunatsiavut where the rate of warming is one of the fastest on the planet.

Patterns of extreme temperature-related catastrophic events in Europe including the Russian Federation: a cross-sectional analysis of the Emergency Events Database

OBJECTIVE

To investigate reported extreme temperature-related catastrophic events and associated mortality on the European continent including the Russian Federation.

DESIGN

Cross-sectional respecting Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria.

SETTINGS

Data source: Emergency Events Database (EM-DAT).

PARTICIPANTS

Search criteria: location-European continent including Russian Federation, time-years 1988 until 2019 (close of database 12 July 2019), catastrophic events-extreme temperatures.

PRIMARY OUTCOME MEASURES

Numbers of heat waves, cold waves, severe winter conditions and associated number of deaths, overall, and per country and year, respecting STROBE criteria.

RESULTS

The most frequent type of the 243 events recorded in EM-DAT were cold waves (54.7%). However, cold waves and severe winter conditions only accounted for 6460 deaths (4.5%), while heat waves were associated with 137 533 deaths (95.5%). The five most severe heat waves in 2003, 2006, 2010, 2013 and 2015 were associated with a total of 135 089 deaths. The most severe heat waves were geographically distributed over the Russian Federation (2010), as well as France, Italy, Spain and Germany, each in 2003.

CONCLUSION

Although cold waves are more frequently reported in EM-DAT, heat waves are the major cause for temperature-related deaths. In order to better protect the public, it is important to address resiliency and vulnerability of populations at risk and age groups.

Examining the association between apparent temperature and incidence of acute excessive drinking in Shenzhen, China

BACKGROUND

This study investigated the relationship between apparent temperature (AT) and the incidence of acute excessive drinking in Shenzhen, China, and estimated attributable risk fraction and absolute excess number for different apparent temperature ranges and subgroups.

METHODS

We conducted a time-series analysis of data on the daily incidence of acute excessive drinking from 2013 to 2017 using a Poisson generalized linear regression model combined with a distributed lag non-linear model. Subgroup analysis by gender and age was also conducted.

RESULTS

This study included 85,833 acute excessive drinkers. Both high and low AT showed significantly non-linear and delayed risk effects on excessive drinking; high AT showed acute and strong effects and low AT showed delayed and mild effects. The total attributable risk fraction (AF) contributed by non-optimum ATs was 10.15% (95% empirical CI [eCI]: 5.32-14.38); the AF was the highest in mild heat (75th-95th percentiles) (4.21%, 95% eCI: 1.74-6.30). The absolute excess number (EN) of excessive drinkers were the highest in extreme cold (≤1st percentile) and extreme heat (≥99th percentile) (205, 95% eCI: 39-335 and 356, 95% eCI: 175-509, respectively).

CONCLUSIONS

Both high and low AT had the positive association with the risk of acute excessive drinking. Extreme ATs led to the greatest excess number of acute excessive drinkers.

[Weather and suicide : Association between meteorological variables and suicidal behavior-a systematic qualitative review article]

BACKGROUND

The effects of current and expected future climate change on mental health outcomes are of increasing concern. In this context, the importance of meteorological factors on suicidal behavior is receiving growing attention in research.

OBJECTIVE

Systematic review article with qualitative synthesis of the currently available literature, looking at the association between meteorological variables and attempted and completed suicide.

MATERIAL AND METHODS

Criteria-based, systematic literature search according to the PRISMA criteria. Peer-reviewed original research studies were included without time limits.

RESULTS AND CONCLUSION

A total of 99 studies were included and grouped according to the research analysis based on daily, weekly, monthly and annual data. The majority of the studies reported a statistical association with at least one meteorological variable. The most consistent positive correlation was shown between temperature and suicidal behavior. However, the results are not conclusive and in part contradictory. The reported studies differed distinctively in terms of study design. Meteorological parameters may be associated with suicidal behavior. Future research in this area is needed to provide further clarity. Despite existing knowledge gaps, the current findings may have implications for suicide prevention plans.

Influence of Heat Waves on Daily Hospital Visits for Mental Illness in Jinan, China-A Case-Crossover Study

Background: Given that more frequent and intensive extreme heat events have been projected based on climate change modeling, it is of significance to have a better understanding of the association between heat waves and mental illnesses. This study aimed to explore the effects of heat waves on daily hospital visits for mental illness in the summer of 2010 in Jinan, China. Methods: A symmetric bidirectional case-crossover study was firstly conducted to determine the relationship between daily hospital visits for mental illness and heat waves in Jinan in 2010. Multifactor logistic regression analysis was then used to analyze the influencing factors for daily hospital visits for mental illness during the heat wave periods. Results: Multivariable analysis showed that the heat wave events were associated with an increased risk of mental illness. The largest odds ratios (ORs) of the heat waves for daily hospital visits for mental illness were 2.231 (95% confidence interval (CI): 1.436–3.466) at a 3-day lag, 2.836 (95% CI: 1.776–4.525) at a 2-day lag, 3.178 (95% CI: 1.995–5.064) at a 3-day lag, and 2.988 (95% CI: 2.158–4.140) at a 2-day lag for the first, second, third, and fourth heat waves, respectively. The elderly, urban residents, outdoor workers, and singles may be high-risk populations for developing heat wave-related mental illness. Conclusions: Our study has supported that there is a positive association between heat waves and hospital visits for mental illness in the study site. Age, home address, occupation, and marital status were associated with daily hospital visits for mental illness during the heat wave periods.

Addressing Mental Health in a Changing Climate: Incorporating Mental Health Indicators into Climate Change and Health Vulnerability and Adaptation Assessments

A growing number of health authorities around the world are conducting climate change and health vulnerability and adaptation assessments; however, few explore impacts and adaptations related to mental health. We argue for an expanded conceptualization of health that includes both the physiological and psychological aspects of climate change and health. Through a review of the global literature on mental health and climate change, this analytical review explores how mental health can be integrated into climate change and health vulnerability assessments and concludes with recommendations for integrating mental health within climate change and health vulnerability and adaptation assessments.

Climate change and mental health: risks, impacts and priority actions

BACKGROUND

This article provides an overview of the current and projected climate change risks and impacts to mental health and provides recommendations for priority actions to address the mental health consequences of climate change.

DISCUSSION AND CONCLUSION

The authors argue the following three points: firstly, while attribution of mental health outcomes to specific climate change risks remains challenging, there are a number of opportunities available to advance the field of mental health and climate change with more empirical research in this domain; secondly, the risks and impacts of climate change on mental health are already rapidly accelerating, resulting in a number of direct, indirect, and overarching effects that disproportionally affect those who are most marginalized; and, thirdly, interventions to address climate change and mental health need to be coordinated and rooted in active hope in order to tackle the problem in a holistic manner. This discussion paper concludes with recommendations for priority actions to address the mental health consequences of climate change.

Mental disease-related emergency admissions attributable to hot temperatures

OBJECTIVE

The association between high temperature and mental disease has been the focus of several studies worldwide. However, no studies have focused on the mental disease burden attributable to hot temperature. Here, we aim to quantify the risk attributed to hot temperatures based on the exposure-lag-response relationship between temperature and mental diseases.

METHOD

From data on daily temperature and emergency admissions (EA) for mental diseases collected from 6 major cities (Seoul, Incheon, Daejeon, Daegu, Busan, and Gwangju in South Korea) over a period of 11years (2003-2013), we estimated temperature-disease associations using a distributed lag non-linear model, and we pooled the data by city through multivariate meta-analysis. Cumulative relative risk and attributable risks were calculated for extreme hot temperatures, defined as the 99th percentile relative to the 50th percentile of temperatures.

RESULTS

The strongest association between mental disease and high temperature was seen within a period of 0-4days of high temperature exposure. Our results reveal that 14.6% of EA for mental disease were due to extreme hot temperatures, and the elderly were more susceptible (19.1%). Specific mental diseases, including anxiety, dementia, schizophrenia, and depression, also showed significant risk attributed to hot temperatures. Of all EA for anxiety, 31.6% were attributed to extremely hot temperatures.

CONCLUSIONS

High temperature was responsible for an attributable risk for mental disease, and the burden was higher in the elderly. This finding has important implications for designing appropriate public health policies to minimize the impact of high temperature on mental health.

Climate Change, Public Health, and Policy: A California Case Study

Anthropogenic activity will bring immediate changes and disruptions to the global climate with accompanying health implications. Although policymakers and public health advocates are beginning to acknowledge the health implications of climate change, current policy approaches are lagging behind. We proposed that 4 key policy principles are critical to successful policymaking in this arena: mainstreaming, linking mitigation and adaptation policy, applying population perspectives, and coordination. We explored California's progress in addressing the public health challenges of climate change in the San Joaquin Valley as an example. We discussed issues of mental health and climate change, and used the San Joaquin Valley of California as an example to explore policy approaches to health issues and climate change. The California experience is instructive for other jurisdictions.

Risk characterization of hospitalizations for mental illness and/or behavioral disorders with concurrent heat-related illness

Background

Many studies have found significant associations between high ambient temperatures and increases in heat-related morbidity and mortality. Several studies have demonstrated that increases in heat-related hospitalizations are elevated among individuals with diagnosed mental illnesses and/or behavioral disorders (MBD). However, there are a limited number of studies regarding risk factors associated with specific mental illnesses that contribute, at least in part, to heat-related illnesses (HRI) in the United States.

Objective

To identify and characterize individual and environmental risk factors associated with MBD hospitalizations with a concurrent HRI diagnosis.

Methods

This study uses hospitalization data from the Nationwide Inpatient Sample (2001–2010). Descriptive analyses of primary and secondary diagnoses of MBDs with an HRI were examined. Risk ratios (RR) were calculated from multivariable models to identify risk factors for hospitalizations among patients with mental illnesses and/or behavioral disorders and HRI.

Results

Nondependent alcohol/drug abuse, dementia, and schizophrenia were among the disorders that were associated with increased frequency of HRI hospitalizations among MBD patients. Increased risk of MBD hospitalizations with HRI was observed for Males (RR, 3.06), African Americans (RR, 1.16), Native Americans (RR, 1.70), uninsured (RR, 1.92), and those 40 years and older, compared to MBD hospitalizations alone.

Conclusions

Previous studies outside the U.S. have found that dementia and schizophrenia are significant risk factors for HRI hospitalizations. Our results suggest that hospitalizations among substance abusers may also be an important risk factor associated with heat morbidity. Improved understanding of these relative risks could help inform future public health strategies.

The effect of ambient temperature on type-2-diabetes: case-crossover analysis of 4+ million GP consultations across England

BACKGROUND

Given the double jeopardy of global increases in rates of obesity and climate change, it is increasingly important to recognise the dangers posed to diabetic patients during periods of extreme weather. We aimed to characterise the associations between ambient temperature and general medical practitioner consultations made by a cohort of type-2 diabetic patients. Evidence on the effects of temperature variation in the primary care setting is currently limited.

METHODS

Case-crossover analysis of 4,474,943 consultations in England during 2012-2014, linked to localised temperature at place of residence for each patient. Conditional logistic regression was used to assess associations between each temperature-related consultation and control days matched on day-of-week.

RESULTS

There was an increased odds of seeking medical consultation associated with high temperatures: Odds ratio (OR) = 1.097 (95% confidence interval = 1.041, 1.156) per 1 °C increase above 22 °C. Odds during low temperatures below 0 °C were also significantly raised: OR = 1.024 (1.019, 1.030). Heat-related consultations were particularly high among diabetics with cardiovascular comorbidities: OR = 1.171 (1.031, 1.331), but there was no heightened risk with renal failure or neuropathy comorbidities. Surprisingly, lower odds of heat-related consultation were associated with the use of diuretics, anticholinergics, antipsychotics or antidepressants compared to non-use, especially among those with cardiovascular comorbidities, although differences were not statistically significant.

CONCLUSIONS

Type-2 diabetic patients are at increased odds of medical consultation during days of temperature extremes, especially during hot weather. The common assumption that certain medication use heightens the risk of heat illness was not borne-out by our study on diabetics in a primary care setting and such advice may need to be reconsidered in heat protection plans.

Heatwaves and Hospital Admissions for Mental Disorders in Northern Vietnam

Studies in high-income countries have shown an association between heatwaves and hospital admissions for mental disorders. It is unknown whether such associations exist in subtropical nations like Vietnam. The study aim was to investigate whether hospital admissions for mental disorders may be triggered, or exacerbated, by heat exposure and heatwaves, in a low- and middle-income country, Vietnam. For this, we used data from the Hanoi Mental Hospital over five years (2008–2012) to estimate the effect of heatwaves on admissions for mental disorders. A zero-inflated negative binomial regression model accounting for seasonality, time trend, days of week, and mean humidity was used to analyse the relationship. Heatwave events were mainly studied as periods of three or seven consecutive days above the threshold of 35°C daily maximum temperature (90^th percentile). The study result showed heatwaves increased the risk for admission in the whole group of mental disorders (F00-79) for more persistent heatwaves of at least 3 days when compared with non-heatwave periods. The relative risks were estimated at 1.04 (0.95–1.13), 1.15 (1.005–1.31), and 1.36 (1–1.90) for a one-, three- and seven-day heatwave, respectively. Admissions for mental disorders increased among men, residents in rural communities, and the elderly population during heatwaves. The groups of organic mental disorders, including symptomatic illnesses (F0-9) and mental retardation (F70-79), had increased admissions during heatwaves. The findings are novel in their focus on heatwave impact on mental diseases in a population habituating in a subtropical low- and middle-income country characterized by rapid epidemiological transitions and environmental changes.

Climate change: challenges and opportunities for global health

IMPORTANCE

Health is inextricably linked to climate change. It is important for clinicians to understand this relationship in order to discuss associated health risks with their patients and to inform public policy.

OBJECTIVES

To provide new US-based temperature projections from downscaled climate modeling and to review recent studies on health risks related to climate change and the cobenefits of efforts to mitigate greenhouse gas emissions.

DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS

We searched PubMed and Google Scholar from 2009 to 2014 for articles related to climate change and health, focused on governmental reports, predictive models, and empirical epidemiological studies. Of the more than 250 abstracts reviewed, 56 articles were selected. In addition, we analyzed climate data averaged over 13 climate models and based future projections on downscaled probability distributions of the daily maximum temperature for 2046-2065. We also compared maximum daily 8-hour average ozone with air temperature data taken from the National Oceanic and Atmospheric Administration, National Climate Data Center.

RESULTS

By 2050, many US cities may experience more frequent extreme heat days. For example, New York and Milwaukee may have 3 times their current average number of days hotter than 32°C (90°F). High temperatures are also strongly associated with ozone exceedance days, for example, in Chicago, Illinois. The adverse health aspects related to climate change may include heat-related disorders, such as heat stress and economic consequences of reduced work capacity; respiratory disorders, including those exacerbated by air pollution and aeroallergens, such as asthma; infectious diseases, including vectorborne diseases and waterborne diseases, such as childhood gastrointestinal diseases; food insecurity, including reduced crop yields and an increase in plant diseases; and mental health disorders, such as posttraumatic stress disorder and depression, that are associated with natural disasters. Substantial health and economic cobenefits could be associated with reductions in fossil fuel combustion. For example, greenhouse gas emission policies may yield net economic benefit, with health benefits from air quality improvements potentially offsetting the cost of US and international carbon policies.

CONCLUSIONS AND RELEVANCE

Evidence over the past 20 years indicates that climate change can be associated with adverse health outcomes. Health care professionals have an important role in understanding and communicating the related potential health concerns and the cobenefits from policies to reduce greenhouse gas emissions.

Health impacts of heat in a changing climate: how can emerging science inform urban adaptation planning?

Extreme heat is one of the most important global causes of weather-related mortality, and climate change is leading to more frequent and intense heat waves. Recent epidemiologic findings on heat-related health impacts have reinforced our understanding of mortality impacts of extreme heat and have shown a range of impacts on morbidity outcomes including cardiovascular, respiratory and mental health responses. Evidence is also emerging on temporal trends towards decreasing exposure-response, probably reflecting autonomous population adaptation. Many cities are actively engaged in the development of heat adaptation plans to reduce future health impacts. Epidemiologic research into the evolution of local heat-health responses over time can greatly aid adaptation planning for heat, prevention of adverse health outcomes among vulnerable populations, as well as evaluation of new interventions. Such research will be facilitated by the formation of research partnerships involving epidemiologists, climate scientists, and local stakeholders.

Heat-related illness: a hot topic in critical care

With current predictions of climate change, the incidence of heat-related illnesses is projected to increase. Heat-related illnesses occur on a continuum from mild symptoms to fatalities. To prevent heat-related illnesses, nurses should have comprehension of persons at risk. Primary treatment of heat-related illness centers on cooling, but not overcooling, the patient. Heatstroke involves coagulopathies and cytokines, and can result in systemic inflammatory response syndrome and multiple organ dysfunction. Critical care nursing intervention requires more than effective cooling to support bodily processes that have been damaged or destroyed by the pathophysiology of heatstroke.

Extreme weather-related health needs of people who are homeless

To identify the extreme weather-related health needs of homeless people and the response by homeless service providers in Adelaide, South Australia, a five-phased qualitative interpretive study was undertaken. (1) Literature review, followed by semi-structured interviews with 25 homeless people to ascertain health needs during extreme weather events. (2) Identification of homeless services. (3) Semi-structured interviews with 16 homeless service providers regarding their response to the health needs of homeless people at times of extreme weather. (4) Gap analysis. (5) Suggestions for policy and planning. People experiencing homelessness describe adverse health impacts more from extreme cold, than extreme hot weather. They considered their health suffered more, because of wet bedding, clothes and shoes. They felt more depressed and less able to keep themselves well during cold, wet winters. However, homeless service providers were more focussed on planning for extra service responses during times of extreme heat rather than extreme cold. Even though a city may be considered to have a temperate climate with a history of very hot summers, primary homeless populations have health needs during winter months. The experiences and needs of homeless people should be considered in extreme weather policy and when planning responses.

Heatwave early warning systems and adaptation advice to reduce human health consequences of heatwaves

Introduction: With climate change, there has been an increase in the frequency, intensity and duration of heatwave events. In response to the devastating mortality and morbidity of recent heatwave events, many countries have introduced heatwave early warning systems (HEWS). HEWS are designed to reduce the avoidable human health consequences of heatwaves through timely notification of prevention measures to vulnerable populations. Objective: To identify the key characteristics of HEWS in European countries to help inform modification of current, and development of, new systems and plans. Methods: We searched the internet to identify HEWS policy or government documents for 33 European countries and requested information from relevant organizations. We translated the HEWS documents and extracted details on the trigger indicators, thresholds for action, notification strategies, message intermediaries, communication and dissemination strategies, prevention strategies recommended and specified target audiences. Findings and Conclusions: Twelve European countries have HEWS. Although there are many similarities among the HEWS, there also are differences in key characteristics that could inform improvements in heatwave early warning plans.