The Complexity of Climate Change as a Determinant of Mental Health

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The world is facing an era of climate crisis. The year 2023 was the warmest on record since the Industrial Revolution, underscoring the undeniable evidence of ongoing global warming. This presents a critical issue, as global average temperatures have now surpassed the 1.5 °C threshold established by the Paris Agreement in 2015 on multiple occasions and in various regions across the globe. The current trajectory is concerning, with predictions indicating that temperatures will continue to rise if no action is taken.¹

The recent Conference of Parties (COP) 28 United Nations Climate Change Conference in Dubai, United Arab Emirates, resulted in a consensus among parties to initiate an energy transition toward a phaseout of fossil fuels. This is a crucial step, as fossil fuels are a major source of greenhouse gases, pollution, and global warming. The ramifications of rising temperatures are profound, affecting the planet, states, communities, and individuals in diverse and interconnected ways.

Climate is a complex system characterized by multiple pathways of development, alternating periods of gradual and rapid change, feedback loops and nonlinear dynamics, thresholds, tipping points, and shifts among pathways.² In a globalized society, all is intertwined. Ecosystems are subjects in a complex network of interactions, and each part of the world that is affected by the effects of climate change has consequences on the others.

In the context of climate change, these characteristics can lead to acute, subacute, and chronic environmental events and changes. The impact of climate change–related events can vary, from acute to chronic occurrences that are experienced directly or indirectly.

Acute events are the fast-onset disasters, such as extreme weather events (eg, typhoons, cyclones, floods, wildfires, heat waves), while the subacute events are the slow-onset events such as droughts.

Chronic events refer to slow environmental changes, such as the rise of sea levels and, in the future, the disappearance of islands (eg, the Pacific Islands) or cities, loss of biodiversity, and/or mass extinction. All these events entail both direct and indirect impacts that can coexist, overlap, and be nested within each other.³

The influence of these events on mental health and well-being can also be direct or indirect. Individuals can be directly affected by experiencing climate-related extreme events such as floods and tornadoes. This exposure involves a physical risk and, at first, attempting to survive the disaster, which may cause trauma or death, exposure to vector-borne diseases and disaster-related pathologies, as well as mental diseases like trauma, depression and other mood disorders, anxiety disorder, substance abuse, and suicide.⁴

Additionally, witnessing the calamities, living near the affected area, and learning about an event, even from a distance, are all ways an individual may experience indirect repercussions from climate events. The experience of subacute and chronic events also leads to onset of the so-called psychoterratic syndromes, emotional states specifically correlated with living or witnessing climate change. These emotions include solastalgia, eco-anxiety, eco-grief, eco-trauma, climate anxiety, and ecological posttraumatic stress disorder (PTSD), as well as denial and apathy.⁵

All the extreme and slow-onset events carry societal costs in terms of population mental health, premature deaths, reduced well-being, breakdown of communities or societies, disruption to socioeconomic and political conditions, and increased forced migration and conflicts.⁶

Additionally, different individuals may experience climate change in different ways. Vulnerable individuals or populations may be particularly sensitive to these types of events and may be more prone to developing psychiatric disorders.

Vulnerable groups include women, youth, and the elderly, individuals with preexisting physical or mental illnesses, Indigenous populations, and individuals with low socioeconomic status. Some scientists studying the climate and eco-activists may be more exposed to climate-related information and, therefore, more sensitive to its impact.⁴

Environmental Determinants

The mind and the planet are connected deeply, on multiple levels, and in a complex way. Numerous climate determinants have been linked to mental health, and understanding this is crucial for promoting well-being and developing effective interventions to address mental health challenges in these times of climate crisis. The determinants of mental health operate at 4 levels (Figure), interact with each other, and are influenced by various protective and risk factors.⁷

Figure. The 4 Levels of the Determinants of Mental Health⁷

The determinants of health are defined as the range of personal, social, economic, and environmental factors that influence physical and mental health. Recognizing the environment as a significant factor affecting individual health entails acknowledging the importance of the environment as a determinant of mental health.

The environmental determinant is both from nature (the non-human element that includes geographical areas and encompasses the interactions among all living species, as well as the elements and phenomena present in Earth’s lands, waters, and biodiversity) and from the built environment (human-made surroundings that serve as the backdrop for human activities like living, working, and recreation).⁸

In the era of climate change, environmental determinants can influence each of the 4 levels of mental health. At the personal level, an increasing number of individuals are exposed to the effects of climate change, both extreme and slow-onset events. These have an impact on mental health, especially in vulnerable individuals.

Disconnection from the natural environment and increased urbanization also contribute to environmental influences on personal health. Living in the city is a risk factor due to the adverse effects of air pollution, noise pollution, and distance from green environments.

At the family and community levels, having low socioeconomic status, being a member of an already at-risk group, and seeing one’s homeland and community places being threatened by climate change can be a risk factor for adverse climate effects. Protective community factors are given by the level of closeness and cohesion within a group following a disaster and being together and coping through pro-environmental actions.

At the society level, indirect psychosocial impacts are triggered by weather disasters, infrastructure damages, or the experience of economic hardship.³ Furthermore, the escalation of climate change may push the planet past critical thresholds, potentially leading to societal collapse. However, the economic and political aspects of society may cooperate for mitigation of climate change.

For example, during COP 28, a “loss and damage fund” was established to address the damage of climate disasters and to support the vulnerable communities that are affected by it.

Ecotherapy

Nature is an environmental determinant of mental health and well-being. Numerous studies suggest that experiences in nature can be beneficial for health and well-being. Nature is effective for mitigating medical disorders such as hypertension and cardiovascular disease, obesity, diabetes, postsurgical recovery, and sleep disturbance, and can help increase attentiveness, brain capacity, and creativity.

Much evidence suggests that spending time in nature has mental health benefits and can decrease the risk of mental illnesses and psychosocial conditions like mood disorders, depression, anxiety disorder, stress, and PTSD. For children, spending time in nature is beneficial for behavioral disorders such as attention-deficit/hyperactivity disorder and for lowering the risk of onset of psychiatric disorders in older age.^9,10

Activities in nature come in many forms, including therapeutic horticulture, pet therapy, therapeutic use of agricultural landscapes and farming practices, conservation work, physical exercise outdoor in parks and the countryside, nature-related arts and crafts, and specific ecotherapy techniques.⁹

Although many of these activities can be done alone, they may also be done socially to increase the sense of community and cohesion in a specific group. In general, spending time in nature is beneficial for physical, mental, and emotional health, so clinicians should encourage patients to engage in these types of activities.

Being aware of the effects of climate change can also lead individuals to get more involved in pro-environmental behaviors. These actions may involve activism in environmental organizations, non-activist behavior in the public sphere (eg, petitioning on environmental issues), private actions (eg, saving energy, purchasing recycled goods), and organizational behavior (eg, product design).¹¹ The more these actions are perceived as meaningful, the stronger their positive impact on subjective well-being will be.¹²

This type of behavior benefits not only the individual but also the community and the entire planet. The connection that occurs between climate change and individuals can be positive when it starts consciously from the individuals themselves.

Concluding Thoughts

Being aware of climate change adds a layer of complexity to discussions surrounding individual well-being and mental health. Mental health is influenced not only by individual biology, but also by social, ecological, and environmental determinants. Recognizing and addressing these connections comprehensively is essential for promoting individual and collective well-being.

Mental health clinicians must be aware of the effects of climate change on mental health in individuals and communities and they must encourage individuals to engage in ecotherapy techniques, pro-environmental behaviors, and behaviors promoting social and community cohesion.

Dr Betrò is a psychiatrist and psychotherapist affiliated with the Istituto di Psicopatologia in Rome, Italy.

References

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2. Folke C, Jansson Å, Rockström J, et al. Reconnecting to the biosphere. Ambio. 2011;40(7):719-738.

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8. Headway – Mental Health Index 2.0 Report. The European House - Ambrosetti. 2022. Accessed March 4, 2024. https://eventi.ambrosetti.eu/headway/wp-content/uploads/sites/225/2022/09/220927_Headway_Mental-Health-Index-2.0_Report-1.pdf

9. Chaudhury P, Banerjee D. “Recovering with nature”: a review of ecotherapy and implications for the COVID-19 pandemic. Front Public Health. 2020;8:604440. Retracted in: Front Public Health. 2023;10:1124835.

10. Jimenez MP, DeVille NV, Elliott EG, et al. Associations between nature exposure and health: a review of the evidence. Int J Environ Res Public Health. 2021;18(9):4790.

11. Sawitri DR, Hadiyanto HH, Hadi SP. Pro-environmental behavior from a social cognitive theory perspective. Procedia Environ Sci. 2015;23:27-33.

12. Zawadzki SJ, Steg L, Bouman T. Meta-analytic evidence for a robust and positive association between individuals’ pro-environmental behaviors and their subjective wellbeing. Environ Res Lett. 2020;15:123007.