Changing the Way Climate Change Psychiatry Is Researched: A Medical Student Perspective

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In an ever-changing world, the effects of climate change lay far beyond volatile weather and melting ice caps.The intersection of medicine and environmental issues has never been more far-reaching, and its ubiquitous nature ensures that individuals of all tongues and cultures are within its reach.

Being a medical student through this global transition is frustrating. While we might learn the fundamental skills required to treat common psychiatric illnesses, there are no guidelines on how to help patients navigate the complexities of climate change. As we ourselves experience the exponential destruction of the climate crisis, a sense of foreboding and urgency to acquire these therapeutic tools grows stronger. Part of the onus certainly falls on the institutions that train future doctors. Medical schools must strive to create a culture and curriculum that educates learners on how all areas of health are impacted by climate change. Outside of basic instruction to empathize with patients adversely affected by climate change, comprehensive climate and health curricula have been notably absent in our education.¹ This must be reexamined. However, it is our obligation as the next generation of psychiatrists to disrupt the status quo and highlight additional ways to make a difference for the field going forward.

One way in which medical students and other future professionals may spur impactful change is to investigate and optimize how climate change psychiatry conducts its research. A reasonable explanation for the lack of student adequate training might stem from a lack of robust research into this topic. While medical governing bodies such as the American Psychiatric Association have made progress in calling for research in climate psychiatry, there remains a severe paucity in funding. In order to impact health outcomes and education on this topic, future research must have the capacity to be translational. Our goal for this article is to highlight a recent scientific effort which sets a new standard in climate change psychiatric research and exemplifies the kind of future work medical students and providers should aim to create amidst our fight against climate destruction.

The New Standard in Climate Change Psychiatric Research

“Effects of Urban Living Environments on Mental Health in Adults” was published by Xu et al in Nature in April of 2023. The objectives of the paper are written succinctly in the abstract:

While individual factors of an urban environment have been investigated in isolation, no attempt has been made to model how complex, real-life exposure to living in the city relates to brain and mental health, and how this is moderated by genetic factors. Using the data of 156,075 participants from the UK Biobank, we carried out sparse canonical correlation analysis to investigate the relationships between urban environments and psychiatric symptoms.

The researchers identified 128 urban living environment variables (eg, traffic, air pollution, proximity to water) corresponding to participants’ home addresses and self-polled participants to identify existing psychiatric symptoms. Survey responses were used to create 3 psychiatric symptom groups (affective symptom group, anxiety symptom group, and emotional instability group). Researchers then determined which environmental factors were contributory to each psychiatric symptom group. For example, in the affective symptom group, high air pollution was positively correlated with symptoms, while proximity to water was protective to symptoms.

Genome-wide association studies were also conducted and revealed genetic association with certain symptom groups. Exemplary findings include single nucleotide polymorphisms (SNPs) such as rs77641763 in the anxiety group, which was associated with suicidal thoughts and behaviors. Researchers posit that these SNPs are integral for ribonucleoprotein binding involved in serotonin metabolism.

Finally, brain microvolume differences were studied in relation to environmental variables and symptom groups. One finding describes regional brain differences in the frontal pole, amygdala, precentral gyrus, and the insular cortex that were discovered to be positively correlated with symptoms in the emotional instability group.

Considerations for the Future

The structure of this research is a model for future studies and come with several implications for the future of climate change psychiatric research. While some of the following considerations are tailored to this specific study, conclusions are applicable to all psychiatric climate change studies to come.

1. Targeted interventions. The study demonstrates the complex interplay between urban environmental factors, genomics, brain function, and mental health. These insights may guide the development of targeted intervention. For instance, public health initiatives may choose to focus on neurobehavioral interventions to equip individuals with adaptive coping skills based on their specific microenvironmental profile.

2. Urban planning and climate resilience. It is not surprising that dense urban development without green spaces may carry negative mental health effects.^2,3 Regardless, urban planners should incorporate these findings in the creation of future designs. Construction of urban areas centered around robust green spaces would not only bolster improved mental health outcomes but also aid in combating climate change itself.

3. Public health strategy. This study emphasizes that the tools for comprehensive public health strategy need to factor in the mental health consequences of urban living. In analyzing study data, goals for public policy which positively affect urban residents may be identified, with further implications for community-level changes and the grassroots organizations that fight to improve local living conditions. Future public health policy should consider microenvironmental factors that have been proven in studies to impact the mental health of its constituents.

4. Genetic considerations. Recognition of specific genomic markers that influence mental health within certain living environments underscores the potential for individualized medicine. Genetic testing for those presenting with mental health symptoms may ultimately lead to personalized treatment plans and improved outcomes.

5. Interdisciplinary collaboration. The magnitude and complexity of this study showcases that future psychiatric research in climate change may necessitate an interdisciplinary team with diverse perspectives. Intentional interdisciplinary efforts will be needed to create research that is truly translational in the climate crisis.

6. Need for longitudinal research with diverse populations and environments. To fully comprehend the impact of climate change, more longitudinal studies are needed. Long-term studies should focus on diverse populations and environments, with special attention paid to the historical context of environmental racism. Generalizability of all conclusions should be analyzed carefully.

7. Activism and anti-racism. Mere recognition of the role climate change plays in mental health outcomes ideally may bring about additional attention to climate change mitigation efforts and the continued evaluation of the disproportionate impact of harmful environments on those affected by racist government legislation.^4-6

Concluding Thoughts

This dynamic study thoroughly captures the relationship between multivariable climate factors and psychiatric symptoms. These translational findings have the potential to inform and change the way we approach public health, urban planning, and climate resilience in this era of climate crisis. Let us hope that all psychiatrists, both future and current, are inspired by this work and the promise it holds for our patients and planet alike.

Mr Burke is a medical student in Minnesota. Mr Wundrach is a medical student in Minnesota.

References

1. Wortzel JR, Haase E, Mark B, et al. Teaching to our time: a survey study of current opinions and didactics about climate mental health training in US psychiatry residency and fellowship programs. Acad Psychiatry. 2022;46(5):586-587.

2. Callaghan A, McCombe G, Harrold A, et al. The impact of green spaces on mental health in urban settings: a scoping review. J Ment Health. 2021;30(2):179-193.

3. Borgi M, Collachi B, Cirulli F, Medda E. Reduction in the use of green spaces during the COVID-19 pandemic and its impact on mental health. Health Place 2023;83:103093.

4. Mills A. Book review: a new narrative of racial segregation. Berkeley Planning Journal. 2018;29(1).

5. Locke DH, Hall B, Grove JM, et al. Residential housing segregation and urban tree canopy in 37 US cities. Npj Urban Sustainability. 2021;1(15).

6. Grove M, Ogden L, Pickett S, et al. The legacy effect: understanding how segregation and environmental injustice unfold over time in Baltimore. Annals of the American Association of Geographers. 2017;108(2):524-538.