Climate change, climate-related disasters and mental disorder in low- and middle-income countries: a scoping review

Abstract

IntroductionClimate change and climate-related disasters adversely affect mental health. Low- and middle-income countries (LMICs) are particularly vulnerable to the impacts of climate change and climate-related disasters and often lack adequate mental healthcare infrastructure. We used the scoping review methodology to determine how exposure to climate change and climate-related disasters influences the presence of mental disorders among those living in LMICs. We also aimed to recognise existing gaps in this area of literature.MethodsThis review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. To identify relevant studies, we searched five electronic databases (MEDLINE, EMBASE, Global Health, APA PsycInfo and Sociological Abstracts) from 1 January 2007 to 31 December 2019. We also searched the grey literature. Included studies had an adult-focused LMIC population, a climate change or climate-related disaster exposure and a mental disorder outcome. Relevant study information was extracted and synthesised.ResultsFifty-eight studies were identified, most of which (n=48) employed a cross-sectional design. The most commonly studied exposure–outcome combinations were flood-related post-traumatic stress disorder (PTSD) (n=28), flood-related depression (n=15) and storm-related PTSD (n=13). The majority of studies identified a positive exposure–outcome association. However, few studies included a baseline or comparator (ie, unexposed) group, thereby limiting our understanding of the magnitude or nature of this association. There was also great heterogeneity in this literature, making studies difficult to pool or compare. Several research gaps were identified including the lack of longitudinal studies and non-uniformity of geographic coverage.ConclusionTo our knowledge, this was the first scoping review to investigate the relationship between climate change and climate-related disaster exposures and mental disorder outcomes in LMICs. Our findings support the need for further research, but also highlight that mental health should be a priority within LMIC climate change policy considerations.

A Scoping Review of Climate Change, Climate-Related Disasters, and Mental Disorders among Children in Low- and Middle-Income Countries

“…All studies included in this review investigated climate-related disaster exposures such as floods and typhoons, while none investigated broader climate change-related exposures such as gradual changes in temperature and precipitation. A similar pattern was identified in Sharpe and Davison [ 16 ] among an adult-focused LMIC population, where over 90% of the included studies explored climate-related disaster exposures. These exposures are often easier to quantify; climate-related disasters tend to have objective geographical boundaries and set start and end dates.…”

“…Scoping reviews are used to systematically map a heterogeneous body of literature [ 30 ], and we felt it was appropriate given that the settings and designs of studies investigating climate change, climate-related disasters, and mental disorders tend to vary widely. This review aligned with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist [ 31 ] and we followed the same methodological approach as our previous scoping review, which investigated climate change and mental health among adults in LMICs [ 16 ]. The review was based on an unpublished protocol.…”

“…Studies were included if they focused on children, defined as having a study population with a mean age of 18 years or less. This definition corresponded with our previous work on adult-focused populations [ 16 ]; we felt it was important to capture studies that primarily included children but also those that may have included a small proportion of adults (given that this situation was common within our area of literature). We included studies with exposures that were either climate-related natural disasters or were explicitly mentioned by the study author as “climate change”.…”

“…For example, LMICs where health systems are not currently providing comprehensive mental health services, or where populations are living in poverty, insecurity, or conflict may be at an overall greater risk for negative mental health outcomes. Several systematic and scoping reviews have identified LMIC-specific evidence supporting the various negative mental health outcomes associated with climate change and climate-related disasters [ 6 , 14 , 15 , 16 ].…”

2021 Climate and Health Review – Uncharted Territory: Extreme Weather Events and Morbidity

“…A survey in Detroit found recurrent flooding to be common and household factors (eg, roof condition, foundation structure), particularly in rental units, to be important predictors of asthma 70 . A meta-analysis found flooding significantly increased risk of bacillary dysentery in China 71 . A systematic review of floods and mental health in LMICs found an association with post-traumatic stress disorder 72 , while a comprehensive review found a more than 90% likelihood of experiencing any psychosocial impact from all EWEs, particularly for those involving property damage and losses 73 .…”