Medscape - Alicia Ault
Climate
change is a major threat to mental health, the American Psychiatric
Association (APA), warns. The association has joined the growing ranks
of physician groups that are sounding the alarm about the multifactorial
effects that rising seas, temperature extremes, and changing
environments are having on individuals' physical and mental health.
In
a new position statement, the APA focuses on the profound impact of
climate change on mental health, which may include the development or
exacerbation of mental illnesses such as anxiety, depression,
posttraumatic stress disorder (PTSD), or substance abuse.
"Those
with mental health disorders are disproportionately impacted by the
consequences of climate change. APA recognizes and commits to support
and collaborate with patients, communities, and other healthcare
organizations engaged in efforts to mitigate the adverse health and
mental health effects of climate change," the APA statement said.
Climate
change and its weather-related consequences are occurring more
frequently, becoming more destructive, are are occurring in places where
they were not as common before, Joshua C. Morganstein, MD, the lead
author of the position statement, told
Medscape Medical News.
The
APA began working on its climate change response in 2015. After review
by various committees, the association's assembly approved the statement
in November 2016 and submitted it to the board, which gave its backing
in March of this year.
The statement is supported by a growing
body of scientific evidence on the damaging effects of climate change,
said Dr Morganstein. "There's a relatively robust body of literature
about the adverse psychological and behavioral health effects of
weather-related disasters," he said.
Dr Morganstein and coauthor
Robert Ursano, MD, who are both members of the APA's Psychiatric
Dimensions of Disaster Committee and are practicing psychiatrists in
Bethesda, Maryland, also contributed to
the chapter on mental health in a recent key federal report on climate change,
The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment. The report was issued by the US Global Change Research Program in April 2016.
Among the report's main findings for mental health:
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Exposure to disasters results in mental health consequences, some chronic.
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Children, the elderly, people with preexisting mental illness,
the economically disadvantaged, and first responders are at higher risk
for distress and other adverse mental health consequences from climate-
or weather-related disasters. Communities that rely on the natural
environment for sustenance and livelihood, as well as populations living
in areas most susceptible to specific climate change events, are at
increased risk for adverse mental health outcomes.
-
Just the threat of climate change can cause some people to
experience adverse mental health outcomes, and media and popular
representations of climate change can influence stress responses and
mental well-being.
-
Extreme heat can put people with mental illness at higher risk for poor physical and mental health.
Dialing Down the Stress
The
report helped solidify the idea that mental health is just as important
as physical health, especially when it comes to weather-associated
disasters caused by climate change, said Dr Morganstein. "For some
disasters, the mental health effects can vastly exceed the economic
costs or other health effects," he said.
Often, the mental impact
of a natural disaster is lost in the shuffle, he said. Having an
understanding of the potential short- and long-term fallout on mental
well-being is key to preventing worse outcomes, said Dr Morganstein.
ndividuals with existing anxiety or depression or PTSD could see a
worsening of symptoms. Individuals may develop these disorders as a
result of the stress of the event. Distress reactions may also occur in
the form of risky behaviors, such as increased alcohol or drug use, he
added.
Many
individuals will show up in the emergency department or primary care
physician's office first — that's why it's important for psychiatrists
to collaborate with other specialties to help prepare for these
disasters, he said.
For many
individuals, just the thought of climate change is enough to produce
severe anxiety and/or depression, and perhaps a sense of hopelessness.
For others, it gives rise to a strong denial reaction.
Dr
Morganstein said psychiatrists can help dial down stress in patients
—especially those who are more vulnerable because of existing mental
disorders — by giving them pragmatic steps, such as asking them to
determine and understand their child's school emergency plan or their
own workplace emergency plan.
"Feeling
like you can help yourself and feeling like you can help others is a
really important piece of how people can respond to disasters," said Dr
Morganstein.
Another
recommendation, especially for people already prone to anxiety, is to
limit exposure to media, he said. For some, repeated ingestion of
climate change news can increase stress and negative reactions. "We
encourage people to be very cautious about this," said Dr Morganstein.
A
sense of preparedness can help ease stress, at least on a population
level, he said. "We can't control when disasters will occur," he said.
But physicians can help patients "control how well prepared they feel"
for a disaster, said Dr Morganstein.
"Climate Change Is a Fact"
Some
of the Trump administration's appointments and policies — such as
pledging to renegotiate the landmark 2015 Paris agreement to fight
climate change that was backed by the United States and some 200
countries — have caused concern that the public's health will be put at
risk during the next 4 years.
But
the APA's statement was not issued as a rebuke to the new
administration, said Dr Morganstein, noting that it had been in the
works for several years.
The American College of Physicians issued a
position statement on climate change in May 2016.
"The issue of climate change is not political," Nitin Damle, MD, MACP, immediate past president of the ACP, told
Medscape Medical News.
"Climate change is a fact," he said. "It's occurring now, and it's
affecting our patients' health from an individual and a public health
standpoint."
Dr Damle cites
increases in respiratory illness, asthma, and allergies from increased
pollution and longer pollen seasons, heat waves that put people at risk
for heat-related illnesses, and an increase in vector-borne diseases
such as Lyme disease, dengue, West Nile virus, and chikungunya. Forced
migration due to environmental changes such as drought or flooding are
leading to a strain of social relationships, depression, and PTSD, he
said.
The time to take action is now, said Dr Damle.
The ACP is part of the
Medical Society Consortium on Climate and Health, which released a report in March,
Medical Alert! Climate Change Is Harming Our Health.
The
consortium includes the American Academy of Family Physicians, the
American Academy of Pediatrics, the American Congress of Obstetricians
and Gynecologists, and the Society of General Internal Medicine, among
other medical and scientific groups.
The
American Psychological Association is also a member of the consortium.
It, too, released a massive report on the mental health effects of
climate change in March.
Not Politically Motivated
The
report's release was not politically motivated, said Howard Kurtzman,
PhD, the American Psychological Association's acting executive director
for science.
Mental Health and Our Changing Climate: Impacts, Implications, and Guidance, was
an update
of a 2014 report, he said. In fact, when the American Psychological
Association started the update, there was a sense of optimism in the
wake of the Paris accord, Dr Kurtzman told
Medscape Medical News.
The
2017 report — which incorporated more and newer evidence — has received
more attention, likely in part because of the concerns about the Trump
administration, Dr Kurtzman said. But, he also said, "I think people are
ready to hear this message."
The
message? That climate change has effects not only on physical health
—through the spread of disease and the reemergence of old disease, for
example — but also on mental health and that certain communities are at
higher risk for damage from climate change because of where they live or
because they have preexisting mental health issues or live in poverty,
said Dr Kurtzman. "On the other hand, there are ways people and
communities can address this challenge," he said.
That
includes taking political action, and also supporting each other and
learning how to prepare. "We need to find ways to help people and
communities obtain a sense of control," Dr Kurtzman said.
Psychologists
can help patients build resilience and learn how to adapt, he said.
They should also work together with other colleagues in the health
field, said Dr Kurtzman.
"There's much more to be done in terms of us working together, but I'm sure we'd all agree on the importance of that," he said.
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