Eco-anxiety: Towards a medical model and the new framework of ecolalgia.

INTRODUCTION: In the context of global warming, new terms emerged in the global media and in the psychology field to embody the negative feelings which come along with climate change such as 'eco-anxiety' or 'solastalgia'. The pathological character of these emotions is denied although medical opinion is often required for helping people to handle them. Also, no proper medical framework in the field exists to study and care for these patients. METHODS: In this narrative review, we aim to (1) analyse the concept of eco-anxiety by focusing on its history and developed concepts, (2) summarize the different scales built to assess eco-anxiety and (3) propose a new medical framework. RESULTS: We came out with a framework based on the transformation of a physiological adaptative behaviour the 'eco-distress'. It is composed of three dimensions: eco-anger, eco-grief and eco-worry, it is not debilitating in daily life and promotes coping strategies such as management of negative emotions and pro-environmental behaviours (PEB). It can transform itself into a pathological state, the 'ecolalgia', composed of two core dimensions: eco-anxiety and eco-depression, leading to functional impairment and decrease in PEB. If ecolalgia maintains over 15 days, we propose to consider it as a full psychiatric disorder needing medical advice. CONCLUSION: This new framework enables a novel approach that is necessary for the improved management of mental health issues related to climate change.

Climate Anxiety: Current Evidence and Future Directions.

PURPOSE OF REVIEW: Challenging cognitive, somatic, and behavioral responses to climate change are often conceptualized as climate anxiety (CA). Due to the increased recognition of the impacts of climate change on mental health, a growing body of scientific literature is developing. The purpose of this manuscript is to review the current evidence base for CA and propose future research needs for this emerging construct. RECENT FINDINGS: Early evidence supports underlying psychological mechanisms in the development and maintenance of CA, which are similar to other anxiety-related conditions. However, the study of CA poses unique challenges to researchers. The psychological impacts that occur in the context of climate change may be adaptive depending on the imminent threat of natural disasters, forced migration, or other climate-related challenges. Due to the potentially adaptive nature of CA and limited current evidence, a coordinated research program of climate-related distress is necessary. A review of the extant literature identified current gaps in understanding the epidemiology and individual differences that promote CA. Current evidence supports the prominent role of neuroticism, intolerance of uncertainty, and rumination. The development of evidence-based models of climate-related distress may provide a more valid and comprehensive depiction of the impacts of climate change on mental health. Transdiagnostic treatment methods are likely the most appropriate intervention for climate-related distress. As models, measures, and treatments of climate-related distress are developed, it is crucial to incorporate studies of populations most at risk for climate change-related mental health effects.

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.

Eco-anxiety: An adaptive behavior or a mental disorder? Results of a psychometric study.

OBJECTIVE: Eco-anxiety is a complex construct that has been created to grasp the psychological impact of the consequences of global warming. The concept needs a reliably valid questionnaire to better evaluate its impact on the risk of anxiety and depressive disorders. The Eco-Anxiety Questionnaire (EAQ-22) evaluates two dimensions: 'habitual ecological anxiety' and 'distress related to eco-anxiety'. However, a version in French, one of the world's widely spoken languages, was until now lacking. We aimed to translate and validate the French EAQ-22 and to evaluate the prevalence of the level of the two dimensions of eco-anxiety and the relationship with anxiety and depressive symptoms in a representative adult sample of the French general population. METHODS: This study was performed under the auspices of the Institut national du sommeil et de la vigilance (INSV). Participants (18-65 years) were recruited by an institute specialized in conducting online surveys of representative population samples (quota sampling). Two native French speakers and two native English speakers performed a forward-backward translation of the questionnaire. The Hospital Anxiety and Depression scale (HAD) was administered to assess anxiety (HAD-A) and depressive (HAD-D) symptoms and for external validity. Internal structural validity and external validity were analysed. RESULTS: Evaluation was performed on 1004 participants: mean age 43.47 years (SD=13.41, range: [19-66]); 54.1% (n=543) women. Using the HAD, 312 (31.1%) patients had current clinically significant anxiety symptoms (HAD-A>10) and 150 (14.9%) had current clinically significant depressive symptoms (HAD-D>10). Cronbach's alpha coefficient was 0.934, indicating very good internal consistency. Correlation between EAQ-22 and HAD scores was low (r[1004]=0.209, P<0.001), 'habitual ecological anxiety' was correlated less with HAD-A and HAD-D than 'distress related to eco-anxiety', indicating good external validity. CONCLUSION: This study validates the French EAQ-22 and paves the way for using the EAQ-22 as a global tool for assessing eco-anxiety. Further prospective studies are now required to better evaluate the impact of eco-anxiety on the occurrence of anxiety and depressive disorder.

Child and Adolescent Psychological Reactions to Climate Change: A Narrative Review Through an Existential Lens.

PURPOSE OF REVIEW: A narrative review was conducted on research surrounding children's and adolescents' experiences of emotional and mental health and wellbeing in relation to climate change; we also explored potential connections to existential themes. RECENT FINDINGS: Children and adolescents represent a vulnerable group in relation to experiencing negative mental health impacts due to climate change. Further, this population experiences a wide range of emotions in relation to climate change, with most research reporting on worry and anxiety. Several studies that explored associations between such emotions and mental health outcomes found positive associations. Additionally, research suggests that there is an existential underpinning to how climate change is experienced by children and adolescents. Although important contributions have been made in recent years, knowledge gaps remain. An understanding of the psychological responses children and adolescents have in relation to climate change is needed to inform practice and policy. This may be supported by an existential framework.

Pregnancy intentions of young women in Canada in the era of climate change: a qualitative auto-photography study.

BACKGROUND: Climate change poses a global health risk through consequences such as sea level rise, wildfires, and increased air pollution. Children born today and in the future may be disproportionately affected by climate change. As a result, many young adults are rethinking having children. The impacts of the climate crisis on the decision-making of parents is an understudied area of research. This study aims to be one of the first to explore how climate change impacts the pregnancy intentions of young women in Canada and their perspectives towards childbearing. METHODS: We conducted auto-photography and qualitative interviews. Participants were recruited using social media, and were aged 18-25, nulliparous, assigned female at birth, and were either current or previous residents of British Columbia, Canada. We asked participants to take photos that responded to the question, "Show us how climate change impacts your decision to have a family," then complete a virtual, one-on-one interview during which photo-elicitation was employed to guide conversation about participants' decision-making related to childbearing and climate change. We subjected all transcribed interviews to qualitative thematic analysis. RESULTS: We conducted in-depth interviews with seven participants who discussed a total of 33 photographs. Analysis of participants' interviews and photographs identified themes of eco-anxiety, hesitancy towards having children, sense of loss, and a desire for systemic change. Participants experienced anxiety, grief, and loss when faced with thoughts of change associated with their environments. Climate change impacted all but two participants' childbearing decision making, which was found to be interrelated with social-environmental factors, such as cost of living. CONCLUSION: We aimed to identify the ways in which climate change may impact youth decisions to have a family. Further research on this topic is needed to understand the prevalence of this phenomenon, and to build such considerations into climate action policy and family planning tools used among young people.

Validating a measure for eco-anxiety in Portuguese young adults and exploring its associations with environmental action.

BACKGROUND: Worsening environmental conditions may amplify people's emotional responses to an environmental crisis (eco-anxiety). In Portugal, young people seem to be especially concerned about climate change. However, this phenomenon needs to be interpreted using accurate instruments. Thus, this study aimed to validate the Portuguese version of the Hogg Eco-Anxiety Scale (HEAS) in young adults and examine the associations among eco-anxiety, sociodemographic characteristics, and pro-environmental behaviours. METHODS: A survey was administered to 623 Portuguese university students aged between 18 and 25 years. The survey included our Portuguese translation of the HEAS (obtained through a back-translation and pretesting process), a sociodemographic assessment, and questions related to pro-environmental behaviours. Confirmatory factor analysis was conducted to assess the construct validity of the Portuguese version of the HEAS, and global fit indices were used to assess whether the original four-dimensional structure of the scale was reproduced. The reliability of the Portuguese version of the HEAS was evaluated by Cronbach's alpha and the intraclass correlation coefficient. Measurement invariance examined sex differences in scale interpretation. Linear regressions were used to detect whether sociodemographic variables predict eco-anxiety and whether eco-anxiety predicts pro-environmental behaviours. RESULTS: The factorial structure of the original scale was replicated in the Portuguese version of the HEAS, showing good internal consistency, reliability over time and strict invariance between men and women. A higher paternal education level predicted greater eco-anxiety in children. Two dimensions of eco-anxiety-namely, rumination and anxiety about personal impacts on the environment-predicted higher engagement in pro-environmental behaviours. CONCLUSIONS: The translated scale is an appropriate tool to measure eco-anxiety in the Portuguese context and should be used to collect evidence to drive environmental and health policies. An individual's education level should be considered a determinant of their emotional response to environmental conditions. Importantly, eco-anxiety can act as a protective emotional response to preserving the planet.

Eco-emotions and Psychoterratic Syndromes: Reshaping Mental Health Assessment Under Climate Change.

Human activities like greenhouse gas emissions, pollution, and deforestation are largely responsible for climate change and biodiversity loss. The climate is a complex system and scientists are striving to predict, prevent, and address the aforementioned issues in order to avoid reaching tipping points. The threat to humankind is not only physical (ie, heat waves, floods, droughts) but also psychological, especially for some groups. Insecurity, danger, chaos, and an unstable system due to climate change have both short- and long-term psychological effects. In this scenario, the need for new psychological categories is emerging, namely, eco-emotions and psychoterratic syndromes which include eco-anxiety, ecological grief, climate worry, and climate trauma. This paper focuses on these new categories, presenting a summary of each one, including definitions, hypotheses, questions, and testological evaluations, as a useful tool to be consulted by researchers and clinicians and to help them in the therapeutic work. Also, this paper endeavors to distinguish between a psychological stress resulting in a positive outcome, such as pro-environmental behavior, compared to a stress that leads to a psychopathology. Prevention and intervention strategies including social and community support are fundamental to help cope with and mitigate the effect of climate change on mental health. In conclusion, the climate crisis has led to an enormous increase in research on climate change and its consequences on mental health. Researchers and clinicians must be prepared to assess this complex phenomenon and provide help to those who cannot cope with anxiety and climatic mourning.

Eco-Anxiety: An Evolutionary Line from Psychology to Psychopathology.

According to the scientific literature, climate change, due to human activities, can damage the environment, with psycho-physical consequences for humans. The scientific literature has highlighted how severe weather events can cause fear, stress, concern for the future, and eco-anxiety. In light of this information, this study aims to explore the concept of eco-anxiety. However, climate change is still perceived as a secondary problem. It would also be worth investigating the real importance that people attach to environmental issues compared to other circumstances, such as wars or pandemics.

Climate Change Impacts on Mental Health Will Lead to Increased Digitization of Mental Health Care.

PURPOSE OF REVIEW: The evidence for the impact of climate change on the mental health of individuals and communities is reviewed, and the literature on the importance of digital systems in reducing carbon emissions is addressed. RECENT FINDINGS: Most of the climate change impacts on mental health are disaster related, although recent literature on "eco-anxiety," often described as anxiety about the long-term effects of climate change, is emerging. There is strong evidence that the use of telepsychiatry and digital approaches to mental health care can reduce carbon emissions by reducing travel for patients and providers as well as provide effective distance care in disasters. Hybrid care, asynchronous consultations, and care at home are all innovations that will further reduce carbon emissions. The COVID-19 pandemic has rapidly accelerated the digitization of psychiatry, and climate change will continue to drive these changes in the future. Much more research on these overlapping issues is required.

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.

Climate anxiety in Germany.

OBJECTIVES: This study aimed to clarify the level and the correlates of climate anxiety in Germany. STUDY DESIGN: This was a quota-based online survey. METHODS: We used data collected in mid-March 2022 from a sample of the general adult population (n = 3091 individuals aged 18-74 years; March 2022). Climate anxiety was quantified using the Climate Anxiety Scale (ranging from 1 to 7, with higher scores corresponding to higher levels of climate anxiety). RESULTS: The average level of climate anxiety in Germany was 2.0 (standard deviation [SD]: 1.2). It differed between subgroups (e.g. individuals aged 18-29 years: 2.4, SD: 1.3; individuals aged 65-74 years: 1.8, SD: 1.0). Log-linear regressions showed that climate anxiety was higher among younger individuals (ß = -0.005, P < .001), full-time employed individuals (compared with retired individuals, ß = 0.07, P < .01), individuals without chronic conditions (compared with individuals with at least one chronic conditions, ß = -0.08, P < .001), individuals already vaccinated against COVID-19 (compared with individuals not vaccinated against COVID-19, ß = 0.10, P < .001), individuals with higher levels of coronavirus anxiety (ß = 0.06, P < .001), and individuals with greater fear of a conventional war (ß = 0.09, P < .001). CONCLUSIONS: Our study showed a rather low level of climate anxiety. It also revealed some correlates of greater climate anxiety such as higher levels of coronavirus anxiety or greater fear of war. Knowledge about the correlates may assist in addressing individuals at risk for high levels of climate anxiety.

Perspectives on Climate Change and Pediatric Mental Health: a Qualitative Analysis of Interviews with Researchers in the Field.

OBJECTIVE: There is a growing appreciation that climate change is affecting pediatric mental health, yet research in this field is in its infancy. The authors aimed to interview researchers in this space to identify themes that can help shape curricula and inform mentors guiding trainees entering this research area. METHOD: A literature review was completed within PubMed, PsycINFO, and EMBASE for articles written in English and indexed between January 1, 2016, and August 1, 2021. The first and last authors of relevant articles were invited to be interviewed and to recommend other experts, from which 20 of 74 (27%) eligible participants were recruited. Standardized interviews were conducted virtually, transcribed, and qualitatively analyzed. RESULTS: Participant responses clustered into two domains, each comprising three themes: (1) current and future research: epidemiology and education, interventions, and gaps in research; and (2) barriers: limited funding, psychological resistance, and logistical impediments. Research has been primarily limited to the phenomenology of eco-anxiety, the aftermath of natural disasters, and psychoeducational interventions. Participants provided insights into how the field can become more interventional, overcome psychological resistance among colleagues through education, and improve funding through calls for grants specific to this topic. CONCLUSIONS: This study outlines perspectives on the cutting-edge directions of research in climate mental health for children and impediments to its progress. Generalizability is limited by the small sample of experts interviewed; however, these content experts' opinions can inform curriculum development and help mentors support mentees hoping to develop research careers in climate mental health.

Commentary: What price eyeballs? - a commentary/reflection on Benoit, Thomas and Martin (2021).

In a response to a research paper which analyses how US newspapers represent young people and parents in their response to climate crisis, this commentary observes that the newspapers achieve some advantage in selecting frames, which privilege adult behaviour at the expense of actions taken by young people. It suggests that one effect of newspapers' choice to frame teens' awareness and activities surrounding climate change in disparaging terms may be to increase any eco-anxiety by devaluing it. It argues that this is done to benefit the newspapers by supporting rather than challenging the schema of their adult readers, following a commercial rather than societal agenda. A subsidiary effect may be to drive younger people away from mainstream media, which fails to represent their viewpoint and towards misinformation and disinformation from unreliable sources.

Commentary: Three tasks for eco-anxiety research - a commentary on Thompson et al. (2021).

Based on years of interdisciplinary research about eco-anxiety, the author discusses here the new research article by Thompson et al. (2021) and depicts three major challenges for eco-anxiety research. The first challenge is the multifaceted character of anxiety. Eco-anxiety is related to both motivation and distress, as the results of Thompson et al. (2021) also show. The second challenge is the need to know about the coping skills of the person and the social group, when eco-anxiety is measured and especially if its relation to pro-environmental behaviour is studied. There may be high distress, but still the person or group may be able to cope constructively. The third challenge is to integrate knowledge about emotional skills in this kind of research. The author discusses the item related to crying about climate change in recent measures of climate anxiety (Clayton & Karazsia 2020) and links this discussion about coping with the results of Thompson et al. (2021). The new article brings important empirical evidence about the complexity of eco-anxiety, even while the data is limited.

Debate: If not us, then who?

Child and Adolescent Psychiatrists have stressful jobs and huge caseloads, and are ideally placed to play an influential and meaningful role in responding to 'the biggest global health threat of the 21st Century': the eco-crisis. This article describes how a group of child and adolescent psychiatrists responded to the awareness that the impacts of the eco-crisis will increasingly undermine their daily work in the clinic. The article lists the progress this small group of committed individuals have made in raising awareness of the issues and what steps they have taken to guide and support other practitioners who want to play their part. Their future plans are set out with an invitation to join the crucial endeavour.

Review: Ecological awareness, anxiety, and actions among youth and their parents - a qualitative study of newspaper narratives.

BACKGROUND: Despite the growing impact of climate change on mental health, there have been few studies to date investigating how children and teenagers manage their ecological grief and eco-anxiety and how they can leverage it into environmental action. In this scoping review, we analyze lay press narratives about how youth respond to climate change to examine the dynamics between minors and adults around the evolving climate crisis. METHODS: We included articles published between 2018 and 2021 in six of the top ten American newspapers by circulation about young people during the climate crisis. The 131 articles we selected addressed the attitudes of children, adolescents, and parents toward the climate crisis. We conducted a qualitative analysis based on discourse analysis aided by NVivo software. RESULTS: Newspaper articles commonly categorized children, adolescents, and their respective perspectives and experiences around climate change along four patterns of discourse: (a) fierce young activists; (b) adultified children; (c) innocent victims; and/or (d) ultimate saviors. In turn, articles considered parents and adults in one of four paradigmatic ways: (a) experiencing eco-anxiety through parenthood; (b) taming children's eco-anxiety; (c) criticizing youth-led activism; and/or (d) reimagining climate action as a source of meaning in the lives of young people. CONCLUSION: Through the framework of childism, or prejudice against children, we conceptualize immature ways for adults to respond to youths' concerns as a defensive stance against overwhelming climate change anxiety. Alternatively, principles of existential psychology can help inform healthier and more productive responses from parents, clinicians, educators, and public health officials as they seek truthful yet supportive responses to address legitimate ecological threats that will disproportionately affect generations to come.

Place-based civic science-collective environmental action and solidarity for eco-resilience.

BACKGROUND: Educating children and young people (CYP) from marginalized communities about environmental crises poses a unique dilemma as educators strive to prepare them to deal with the climate crisis without compounding the stressors and fear of an unlivable future many already face. We explored how place-based civic science (PBCS) can provide opportunities to engage youth in environmental understanding and action through teamwork in which youth feel that they belong to a group larger than themselves and gain a sense of hope from working with others toward shared goals. We argue that combining PCBS pedagogies of collective action and collaborative learning spaces can help to buffer against distress as CYP grapple with global environmental crises. METHODS: We drew from qualitative responses (student reflections and public presentations) of 486 6-12th graders (majority students of color) on what they learned from participating in PBCS projects. Projects involved egalitarian partnerships between adults from environmental organizations, teachers and student teams studying and acting together to mitigate problems and presenting their efforts in public venues. RESULTS: Students' qualitative responses revealed an identification with their team and its goal forged through the work, respect for their voice, belief in their capacity and confidence to take collective action and even enjoyment of working together to address community concerns. CONCLUSIONS: PBCS through collective learning/action in student teams and nonhierarchical intergenerational partnerships, and connections that CYP forge with organizations in the broader community, can help to build CYP's agency and efficacy while addressing "emotionally heavy" issues such as climate change.