Journal Article Annotations
2022, 2nd Quarter
Annotations by Mary Burke, MD
The relationship between heat waves and increased psychiatric hospitalizations is well-documented. This study amplifies that finding and highlights the vulnerability of older individuals, including in rural areas (who typically are understudied in climate-crisis research). Most of us tend to minimize the gravity of unusual spells of mild weather in the winter. This conclusively shows that we all need to be alert to the higher risk this poses to our patients, not just acutely but also chronically, as we continue to see temperatures rise. The study also points out how multiple pollutants, not just PM2.5, impose a real risk to those with severe mental illness.
Strength and weaknesses:
This study enrolled all individuals enrolled in Medicare in the USA with a primary psychiatric disorder, and all psychiatric admissions due to depression, schizophrenia, or bipolar disorder over 16 years. Levels of heat have only increased since 2016 when the study closed. The study design is rigorous, with a case-crossover design in which persons were matched to themselves on control days (when they were not admitted).
The authors note that they could not account for all potential confounders, and the study only describes correlative data.
The climate and environmental crises are the biggest health issues that we will face in our professional career. Research into mechanisms of environmental/ climate toxicities and mental illness are have also clarified mechanisms of illess for psychiatric disease more generally (such as the role of inflammation or perturbations in glucocorticoid and serotonergic activity). This article reinforces C-L psychiatrists’ role as clinicians who should anticipate worsened outcomes as the environment degrades; patient educators on the risks of heat and pollution; and professional educators who teach that climate and environment, like childhood stress or substance abuse, impact brain health and therefore psychiatric health. More research is needed to inform how typical practice (such as prescribing) may be affected by climate change and how specific interventions may mitigate these adverse outcomes.
Toxic pollution continues to be a major threat to human health. This study estimated that in 2019, 9 million deaths were due to pollution—around 16% of the global total. As with all environmental impacts, morbidity and mortality are felt less in prosperous nations or by wealthier citizens, highlighting how environmental deterioration is a multiplier of determinants of illness. In addition, the study broke down the impact of specific pollutants including lead: “More than 800 million children are estimated to have blood lead concentrations that exceed 5·0 μg/dL…The implications of this finding for children’s intellectual impairment are staggering. Other neurotoxins are abundant and pose developmental threats to children and pregnancies.”
Strength and weaknesses:
This update of a 2015 global survey provides evidence that governments need to act decisively to limit industrial sources of contamination. The article concludes with recommendations for governments and other larger institutions but also emphasized the importance of monitoring toxic exposures—and especially lead—in pregnant women and children.
The authors point out that “The impact of pollution on health remains much greater than that of war, terrorism, malaria, HIV, tuberculosis, drugs, and alcohol, and the number of deaths caused by pollution are on par with those caused by smoking.“ While people can become numb and disconnected in the face of overwhelmingly bad news, in fact, C-L psychiatrists can play an active role in addressing these adverse impacts for patients. Psychiatrists can serve as educators, advocates, and clinicians; at a minimum, we as clinicians can monitor the effect pollutants and heat have on our patients, in particular our pediatric and pregnant patients.