Mental health and psychosocial interventions in the context of climate change: a scoping review.

The evidence on the impacts of climate change on mental health and wellbeing is growing rapidly. The objective of this scoping review is to understand the extent and type of existing mental health and psychosocial interventions aimed at addressing the mental health and psychosocial impacts of climate change. A scoping review methodology was followed. MEDLINE, PsycINFO, and Web of Science databases were searched from inception to May 2022. Comprehensive gray literature search, including expert consultation, was conducted to identify interventions for which peer-reviewed academic literature may not yet be available. Data on intervention type, setting, climate stressor, mental health outcome, evaluation, and any other available details were extracted, and results were summarized narratively. Academic literature search identified 16 records and gray literature search identified a further 24 records. Altogether, 37 unique interventions or packages of interventions were identified. The interventions act at the levels of microsystem, mesosystem, exosystem, and macrosystem through diverse mechanisms. While most interventions have not been formally evaluated, promising preliminary results support interventions in low- and middle-income-country settings disproportionately affected by climate disasters. Interventions from multidisciplinary fields are emerging to reduce psychological distress and enhance mental health and wellbeing in the context of climate change. This scoping review details existing evidence on the interventions and summarizes intervention gaps and lessons learned to inform continued intervention development and scale-up interventions.

Psycho-social factors associated with climate distress, hope and behavioural intentions in young UK residents.

Although the UK has been relatively spared significant geophysical impacts of climate change, many people, youth in particular, are increasingly worried about climate change. The psychological distress associated with the (perceived) threat of climate change has been linked to poorer mental wellbeing but can also promote adaptive responses such as engagement in pro-environmental behaviour. In this mixed methods study, we delve deeper into the experience of 'climate distress' among UK residents aged 16-24 (N = 539). We conducted an online survey assessing general mental health, subjective wellbeing, and climate distress with existing scales. We also included novel questions assessing positive and negative life impacts of climate change, open-ended questions on aspirations and priorities for the future, and engagement in pro-environmental and climate actions. Our findings indicate that mental health factors may contribute to vulnerability to climate distress. Predictably, socio-psychological responses to climate change (i.e., frustration over inaction, lack of control, and shame or guilt about one's own contributions) were linked to higher scores on the climate distress scale. Negatively appraised climate change-related events (i.e., seeing an environment they care about change for the worse) were associated with higher climate distress. Individuals with high climate distress (10.1% of our sample) reported worrying about the impact of climate change on their own future more frequently than any other topic surveyed (including personal finance, career, relationships, politics). Both positive (hope/interest) and negative (anger/frustration) emotions inspired action-taking, especially climate activism, which was negatively predicted by guilt/shame and sadness/fear. Private-sphere pro-environmental actions appeared less driven by strong emotions. Overall, our findings present a more nuanced picture of climate distress in terms of emotional responses, behaviour, and mental health. Longitudinal research is urgently needed to understand how distress may change over time, and the conditions that lead to adaptive and maladaptive outcomes.

Ambient temperature and mental health: a systematic review and meta-analysis.

BACKGROUND: Increasing evidence indicates that ambient outdoor temperature could affect mental health, which is especially concerning in the context of climate change. We aimed to comprehensively analyse the current evidence regarding the associations between ambient temperature and mental health outcomes. METHODS: We did a systematic review and meta-analysis of the evidence regarding associations between ambient outdoor temperature and changes in mental health outcomes. We searched WebOfScience, Embase, PsychINFO, and PubMed for articles published from database origin up to April 7, 2022. Eligible articles were epidemiological, observational studies in humans of all ages, which evaluated real-world responses to ambient outdoor temperature, and had mental health as a documented outcome; studies of manipulated or controlled temperature or those with only physical health outcomes were excluded. All eligible studies were synthesised qualitatively. If three or more studies reported the same or equivalent effect statistics and if they had equivalent exposure, outcome, and metrics, the studies were pooled in a random-effects meta-analysis. The risk of bias for individual studies was assessed using the Newcastle-Ottawa Scale. The quality of evidence across studies was assessed using the Office of Health Assessment and Translation (OHAT) approach. FINDINGS: 114 studies were included in the systematic review, of which 19 were suitable for meta-analysis. Three meta-analyses were conducted for suicide outcomes: a 1°C increase in mean monthly temperature was associated with an increase in incidence of 1·5% (95% CI 0·8-2·2, p<0·001; n=1 563 109, seven effects pooled from three studies); a 1°C increase in mean daily temperature was associated with an increase in incidence of 1·7% (0·3-3·0, p=0·014; n=113 523, five effects pooled from five studies); and a 1°C increase in mean monthly temperature was associated with a risk ratio of 1·01 (95% CI 1·00-1·01, p<0·001; n=111 794, six effects pooled from three studies). Three meta-analyses were conducted for hospital attendance or admission for mental illness: heatwaves versus non-heatwave periods were associated with an increase in incidence of 9·7% (95% CI 7·6-11·9, p<0·001; n=362 086, three studies); the risk ratio at the 99th percentile of daily mean temperature compared with the 50th percentile was 1·02 (95% CI 1·01-1·03, p=0·006; n=532 296, three studies); and no significant association was found between a 10°C increase in daily mean temperature and hospital attendance. In a qualitative narrative synthesis, we found that ambient outdoor temperature (including absolute temperatures, temperature variability, and heatwaves) was positively associated with attempted and completed suicides (86 studies), hospital attendance or admission for mental illness (43 studies), and worse outcomes for community mental health and wellbeing (19 studies), but much of the evidence was of low certainty with high heterogeneity. INTERPRETATION: Increased temperature and temperature variability could be associated with increased cases of suicide and suicidal behaviour, hospital attendance or admission for mental illness, and poor community health and wellbeing. Climate change is likely to increase temperature anomalies, variability, and heatwaves as well as average temperatures; as such, health system leaders and policy makers must be adequately prepared and should develop adaptation strategies. More high-quality, standardised research is required to improve our understanding of these effects. FUNDING: None.

Online peer support training to promote adolescents' emotional support skills, mental health and agency during COVID-19: Randomised controlled trial and qualitative evaluation.

Adolescents often look to their peers for emotional support, so it is critical that they are prepared to take on a supportive role, especially during a health crisis. Using a randomised controlled trial (ISRCTN99248812, 28/05/2020), we tested the short-term efficacy of an online training programme to equip young people with skills to support to their peers' mental wellbeing during the COVID-19 pandemic. In June 2020, one-hundred UK adolescents (aged 16-18) recruited through social media were randomly allocated (1:1) to immediate 5-day peer support training or a wait-list, via an independently generated allocation sequence. Primary outcomes were indicators of ability to help others (motivation, perceived skills, frequency of help provided, compassion to others and connectedness to peers). Secondary outcomes included emotional symptoms, mental wellbeing, and indicators of agency (civic engagement and self-efficacy). We also collected qualitative reports of participants' experience. Assessments were completed at baseline and 1 week post randomisation (primary endpoint), and up to 4 weeks post randomisation (training group only). The training increased support-giving skills, frequency of providing support, compassion and peer connectedness (medium-large-effect sizes), but not motivation to provide support, 1 week post randomisation, compared to controls. Gains in the training group were maintained 4 weeks post randomisation. Training also improved adolescents' mental health and agency, and qualitative reports revealed further positive outcomes including increased self-care and empowerment. Leveraging digital platforms that are familiar to young people, peer support training has the potential to enable adolescents to support their own and their peers' mental wellbeing during a health crisis.

Integrating mental health into climate change education to inspire climate action while safeguarding mental health.

Climate change is the greatest threat humanity faces, and puts at risk the mental health and wellbeing of children and young people. Climate change education must equip children and young people with the knowledge, skills and resilience to live in an uncertain future, sustainably take relevant climate action and work in climate careers. As attention on climate change education grows, this is a critical moment for the mental health community to ensure mental health and wellbeing considerations are embedded. Critically, appropriate integration of mental health can enable these very necessary goals of equipping children and young people to live and work in a future where climate change looms large. This paper explores why promoting good mental health and wellbeing and building psychological resilience can help achieve climate change education outcomes, and why not doing so risks harming children and young people's mental health. It also explores how integrating discussions about emotions, mental health, and coping strategies within climate change education can be a route into wider discussions about mental health, to support children and young people in the context of rising mental health needs. Learning from an existing approach to promoting good mental health and wellbeing in schools (the 'whole school approach') provides the opportunity to explore one avenue through which such an integrated approach could be implemented in practice. Identifying appropriate mechanisms to integrate mental health into climate change education will require co-design and research with educators and young people, and addressing systemic barriers facing the schools sector.

Current understanding of the impact of climate change on mental health within UK parliament.

There is growing evidence that climate change is linked to adverse mental health outcomes, with both direct and indirect impacts already being felt globally, including within the United Kingdom (UK). With the UK parliament tasked with passing legislation to mitigate against and adapt to climate change, it is well placed to take a lead in implementing policies that reduce the impact of climate change on mental health and even provide mental health benefits (e.g., by increasing access to green space). The extent to which the UK parliament considers the relationship between climate change and mental health in its decision-making was previously unknown. We report, through quantitative thematic analysis of the UK Hansard database, that the UK parliament has only infrequently made links between climate change and mental health. Where links have been made, the primary focus of the speeches were around flooding and anxiety. Key mental health impacts of climate change reported in the academic literature, such as high temperature and suicides, or experiences of eco-anxiety, were found to be missing entirely. Further, policies suggested in UK parliament to minimise the impact of climate change on mental health were focused on pushing adaptation measures such as flood defences rather than climate mitigation, indicating potential missed opportunities for effective policies with co-benefits for tackling climate change and mental health simultaneously. Therefore, this research suggests a need to raise awareness for UK policymakers of the costs of climate inaction on mental health, and potential co-benefits of climate action on mental health. Our results provide insight into where links have and have not been made to date, to inform targeted awareness raising and ultimately equip policymakers to protect the UK from the increasingly large impacts of climate change on mental health.

Reflections of mental health professionals on working with and in the climate crisis.

The aim of this paper is to share our experiences of engaging with the climate crisis as citizens and mental health professionals (MHPs). We hope the outputs will usefully validate the experiences of fellow MHPs and support them to reflect on their role in this crisis. We came together as eight MHPs, participating in group discussions and one-one interviews with the first author to reflect on our experiences. The collaboratively generated themes reflect how engagement with the crisis has: (i) disrupted our personal and professional experiences; (ii) helped us adapt and grow; and (iii) enabled us to live, work and act in more accordance with our values. A key reflection was that these experiences are not linear and we continue to wrestle with our responses to the climate crisis. Discussions also elicited visions of how mental health paradigms could be better adapted to meeting the escalating public health need that this crisis is generating. We conclude by advocating for MHPs to process and respond to the climate crisis and recognize that their skills can make a vital contribution to this global challenge.

"Not about us without us" - the feelings and hopes of climate-concerned young people around the world.

The feelings and hopes of young people around the world are often neglected in policymaking and research, with consequences for both their wellbeing and the effectiveness of humanity's response to the climate crisis. Many of them are distressed by climate change's impacts, the inaction of political and corporate leaders, the ways other people respond to their feelings, and the lack of support they have to share their feelings or get involved in meaningful climate-related work. This paper is written by a group of twenty-three concerned young people from fifteen countries. It provides a first-hand account of our deepest feelings, how these feelings affect our daily lives, the support we want to help us cope, and our hopes for a radically more compassionate future. The results are particularly relevant to policymakers, mental health professionals, journalists, educators, and people working with young people more widely.

The role of mental health professionals in the climate crisis: an urgent call to action.

The climate and ecological crisis will constitute the defining public health challenge of the twenty-first century, posing an unprecedented global threat to all determinants of health, and to healthcare delivery systems. We believe that mental health professionals have a crucial role to play in responding to this crisis. Whilst responding to the mental health consequences of the climate crisis will remain a key role for us as mental health professionals, we argue that our remit goes beyond this, and should include advancing public understanding of the climate crisis, highlighting its impact on physical and mental wellbeing, and advocating for systemic changes to limit its impending harms. This paper is an urgent call to action for all mental health professionals to take up a role in the context of the climate and ecological crisis. This paper will describe the relationship between mental health and climate change, and frame it within wider systemic and conceptual frameworks. It will demonstrate that as mental health professionals we are well placed to act as leaders of change-arguing that we have a duty to do so-and suggest actions that can be implemented depending on interests, skill sets and opportunities.

The Impact of Climate Change on Mental Health and Emotional Wellbeing: A Narrative Review of Current Evidence, and its Implications.

Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people's mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.

Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study.

BACKGROUND: The COVID-19 pandemic and climate change are both significant and pressing global challenges, posing threats to public health and wellbeing. Young people are particularly vulnerable to the distress both crises can cause, but understanding of the varied psychological responses to both issues is poor. We aimed to investigate these responses and their links with mental health conditions and feelings of agency. METHODS: We conducted an online survey between Aug 5 and Oct 26, 2020, targeting a diverse sample of young people (aged 16-24 years, n=530) in the UK. The survey was distributed using a combination of a survey panel (panel sample) and direct approaches to youth groups and schools who shared the survey with young people in their networks (community sample). We collected data on respondents' psychological responses to both climate change and the COVID-19 pandemic, their sense of agency to respond to each crisis, and the range of impacts on their lives. We also collected demographics data and screened for mental health and wellbeing indicators. We used non-parametric tests for most statistical comparisons. For paired samples, we used Wilcoxon's signed-rank test, and used Mann-Whitney U-tests or Kruskal-Wallis tests for two or more independent samples. Summed scale scores were considered as interval-level data and analysed with Student's t tests and ANOVAs. Effect sizes are reported as Cohen's d and partial eta-squared (η·2p), respectively. FINDINGS: After excluding 18 suspected bots and 94 incomplete responses, 530 responses were retained for analysis. Of the 518 respondents who provided demographic data, 63% were female, 71·4% were White, and the mean family affluence score was 8·22 (SD 2·29). Most participants (n=343; 70%) did not report a history of diagnosis or treatment for a mental health disorder, but mental health scores indicated a common experience of (relatively mild) symptoms of anxiety, depression, and stress. Although UK youth reported more life disruption and concern for their future due to the COVID-19 pandemic, climate change was associated with significantly greater distress overall, particularly for individuals with low levels of generalised anxiety. The COVID-19 pandemic was more associated with feelings of anxiety, isolation, disconnection, and frustration; distress around loss and grief; and effects on quality of life. Climate change was more likely to evoke emotions such as interest and engagement, guilt, shame, anger, and disgust. The greater distress attributed to climate change overall was due, in particular, to higher levels of guilt, sense of personal responsibility, and greater distress triggered by upsetting media coverage. Agency to address climate change was associated with greater climate distress, but pandemic-related distress and agency were unrelated. INTERPRETATION: The COVID-19 pandemic and climate change are affecting the wellbeing of UK young people in distinct ways, with implications for health service, policy, and research responses. There is a need for mental health practitioners, policy makers, and other societal actors to account for the complex relationship between climate agency, distress, and mental wellbeing in young people. FUNDING: Imperial College London.

Healthy Environments: Understanding Perceptions of Underrepresented Communities in the United Kingdom.

A healthy environment has been defined by global health organisations as one that is safe, supportive of healthy lifestyles, and free of hazards. Such definitions disregard the complexity of what it means for an environment to be perceived as 'healthy'-such as the mental, not just physical, health effects on citizens. This study aimed to understand the attributes that underrepresented groups of the United Kingdom (UK) public assign to healthy environments-an important step for directing public policy and actions to create environments that are inclusive of all citizens. This co-created study involved 95 participants from underrepresented communities in 10 separate focus groups, each facilitated by a community member. Thematic analyses highlighted five key attributes of a healthy environment: sounds and sights, accessibility, safety, familiarity and mental health and wellbeing. This study draws a picture of key attributes underrepresented groups of the UK public assign to healthy environments that is richer than that drawn by existing definitions. These findings illustrate the importance of hearing diverse voices when directing research, policy, and actions that attempt to develop healthy environments for all.

The Computational and Neural Substrates of Ambiguity Avoidance in Anxiety.

Theoretical accounts have linked anxiety to intolerance of ambiguity. However, this relationship has not been well operationalized empirically. Here, we used computational and neuro-imaging methods to characterize anxiety-related differences in aversive decision-making under ambiguity and associated patterns of cortical activity. Adult human participants chose between two urns on each trial. The ratio of tokens ('O's and 'X's) in each urn determined probability of electrical stimulation receipt. A number above each urn indicated the magnitude of stimulation that would be received if a shock was delivered. On ambiguous trials, one of the two urns had tokens occluded. By varying the number of tokens occluded, we manipulated the extent of missing information. At higher levels of missing information, there is greater second order uncertainty, i.e., more uncertainty as to the probability of pulling a given type of token from the urn. Adult human participants demonstrated avoidance of ambiguous options which increased with level of missing information. Extent of 'information-level dependent' ambiguity aversion was significantly positively correlated with trait anxiety. Activity in both the dorsal anterior cingulate cortex and inferior frontal sulcus during the decision-making period increased as a function of missing information. Greater engagement of these regions, on high missing information trials, was observed when participants went on to select the ambiguous option; this was especially apparent in high trait anxious individuals. These findings are consistent with individuals vulnerable to anxiety requiring greater activation of frontal regions supporting rational decision-making to overcome a predisposition to engage in ambiguity avoidance at high levels of missing information.

Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis.

BACKGROUND: Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. OBJECTIVE: The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. METHODS: A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. RESULTS: Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (-25.6%, 95% CI -0.352 to -0.160; P<.001) and anxiety (-15.1%, 95% CI -0.251 to -0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. CONCLUSIONS: D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations.

Listening to Mental Health Crisis Needs at Scale: Using Natural Language Processing to Understand and Evaluate a Mental Health Crisis Text Messaging Service.

The current mental health crisis is a growing public health issue requiring a large-scale response that cannot be met with traditional services alone. Digital support tools are proliferating, yet most are not systematically evaluated, and we know little about their users and their needs. Shout is a free mental health text messaging service run by the charity Mental Health Innovations, which provides support for individuals in the UK experiencing mental or emotional distress and seeking help. Here we study a large data set of anonymised text message conversations and post-conversation surveys compiled through Shout. This data provides an opportunity to hear at scale from those experiencing distress; to better understand mental health needs for people not using traditional mental health services; and to evaluate the impact of a novel form of crisis support. We use natural language processing (NLP) to assess the adherence of volunteers to conversation techniques and formats, and to gain insight into demographic user groups and their behavioural expressions of distress. Our textual analyses achieve accurate classification of conversation stages (weighted accuracy = 88%), behaviours (1-hamming loss = 95%) and texter demographics (weighted accuracy = 96%), exemplifying how the application of NLP to frontline mental health data sets can aid with post-hoc analysis and evaluation of quality of service provision in digital mental health services.

Temporal predictability enhances auditory detection.

Periodic stimuli are common in natural environments and are ecologically relevant, for example, footsteps and vocalizations. This study reports a detectability enhancement for temporally cued, periodic sequences. Target noise bursts (embedded in background noise) arriving at the time points which followed on from an introductory, periodic "cue" sequence were more easily detected (by ∼1.5 dB SNR) than identical noise bursts which randomly deviated from the cued temporal pattern. Temporal predictability and corresponding neuronal "entrainment" have been widely theorized to underlie important processes in auditory scene analysis and to confer perceptual advantage. This is the first study in the auditory domain to clearly demonstrate a perceptual enhancement of temporally predictable, near-threshold stimuli.