Journal Article Annotations
2023, 3rd Quarter
Annotations by Mary G. Burke, MD
This systematic review (144 studies) and meta-analysis (19 suitable studies) used epidemiological and observational studies of the impacts of increased ambient heat on human health. The authors found that suicide risk increased by a statistically significant “1.5% for every 1 degree C increase in mean monthly temperature; a 1 degree C increase in mean daily temperature was associated with an increase in incidence of 1·7%; and a 1 degree C increase in mean monthly temperature was associated with a risk ratio of 1·01.”
In addition, hospital attendance or admission for mental illness during heatwaves vs non-heatwaves showed increase in incidence of 9·7%. This comprehensive scoping review is the second article on this topic by these authors. It may be the most comprehensive review yet of this topic.
Strengths and Weaknesses:
An increasing number of individual epidemiological studies show a relationship between prolonged excess heat and worsening mental health outcomes. This article brings together many of these original data, integrates their findings, and reviews their quality and usefulness. The authors note the heterogeneity of studies and the low certainty of the evidence. They only used articles in English, possibly missing research from the Global South that would add more dimension to the work.
There is growing awareness that increased heat increases the risk for suicidal ideation and completion as well as overall behavioral health impairment. All mental health practitioners should be ready to educate patients on what to expect and how to take care of themselves and family members during prolonged periods of heat. Handouts from the Climate Psychiatry Alliance—addressing heat, psychological distress, and wildfire smoke—can educate C-L psychiatrists, other providers, patients, and families:
This article provides a (non-systematic) review of the state of our scientific understanding of the impacts of wildfire smoke on pregnancy, maternal physical and mental health, and risks to fetal and child development. The review suggests mechanisms of action for the impact of smoke may be due to hormonal/metabolic changes, the effects of fine particulate matter (PM2.5), and psychological distress. The review also notes our current knowledge gaps in providing a blueprint for further investigation and public health mitigation.
Strengths and Weaknesses:
The article is well-referenced, with links to actions needed to improve our public health research and response. These include addressing inequities of impact and access to care. It also notes the need to include community members and clinicians in shaping research questions. It addresses the gaps on our knowledge base.
C-L clinicians working with pregnant, lactating, and postpartum mothers should be aware of the hormonal, metabolic and psychological impacts that may arise from exposure to wildfires, smoke, and related emergencies. Assessing these and providing targeted care can improve our ability to support our patients as climate-related emergencies increase. Researchers in maternal-child mental health can add questions about the impact of climate-related physical and mental adversity. The CDC hosts an excellent website that is of use for clinicians and patients alike.
This opinion piece reviews inequitable reporting of climate harms to women in the Global South. Reasons for this inequity include difficulties accessing data, women’s participation in the informal economy, and historical lack of gender-specific health analyses. The author recommends Heat Action Plans that explicitly recognize and address women’s health vulnerabilities to heat. Consult psychiatrists working with women in the Global South as well as from US areas with extreme heat should be aware of health risks. Clinical assessment of patients should include asking about outdoor activity, access to cooling—especially at night—and hydration, and access to fresh water. It is particularly important for pregnant women who have physiologically altered thermoregulation, are carrying extra weight, and have additional fluid needs.