Helen L. Berry

Climate change and mental health: a causal pathways framework

ObjectivesClimate change will bring more frequent, long lasting and severe adverse weather events and these changes will affect mental health. We propose an explanatory framework to enhance consideration of how these effects may operate and to encourage debate about this important aspect of the health impacts of climate change.MethodsLiterature review.ResultsClimate change may affect mental health directly by exposing people to trauma. It may also affect mental health indirectly, by affecting (1) physical health (for example, extreme heat exposure causes heat exhaustion in vulnerable people, and associated mental health consequences) and (2) community wellbeing. Within community, wellbeing is a sub-process in which climate change erodes physical environments which, in turn, damage social environments. Vulnerable people and places, especially in low-income countries, will be particularly badly affected.ConclusionsDifferent aspects of climate change may affect mental health through direct and indirect pathways, leading to serious mental health problems, possibly including increased suicide mortality. We propose that it is helpful to integrate these pathways in an explanatory framework, which may assist in developing public health policy, practice and research.

Social capital and health in Australia: An overview from the household, income and labour dynamics in Australia survey

Social capital is associated with better health, but components of social capital and their associations with different types of health are rarely explored together. The aim of this study was to use nationally representative data to develop population norms of community participation and explore the relationships between structural and cognitive components of social capital with three forms of health - general health, mental health and physical functioning. Data were taken from Wave 6 (2006) of the Household, Income and Labour Dynamics in Australia Survey. Using individual-level data, the structural component of social capital (community participation) was measured using a twelve-item short-form of the Australian Community Participation Questionnaire, and the cognitive component (social cohesion) by sense of belonging, tangible support, trust and reciprocity. Three subscales of the SF-36 provided measures of health. Multiple hierarchical regression modelling was used to investigate multivariate relationships among these factors. Higher levels of participation were related to higher levels of social cohesion and to all three forms of (better) health, particularly strongly to mental health. These findings could not be accounted for by sex, age, Indigenous status, education, responsibility for dependents, paid work, living alone or poverty. Controlling for these and physical health, structural and cognitive components of social capital were each related to mental health, with support for a possible mediated relationship between the structural component and mental health. Social capital was related to three forms of health, especially to mental health. Notable gender differences in this relationship were evident, with women reporting greater community participation and social cohesion than men, yet worse mental health. Understanding the mechanisms underlying this apparent anomaly needs further exploration. Because community participation is amenable to intervention, subject to causal testing, our findings may assist in the development of programs which are effective in promoting social cohesion and, thereby, mental health.

Climate Change and Farmers’ Mental Health: Risks and Responses

Climate change is exacerbating climate variability, evident in more frequent and severe weather-related disasters, such as droughts, fires, and floods. Most of what is known about the possible effects of climate change on rural mental health relates to prolonged drought. But though drought is known to be a disproportionate and general stressor, evidence is mixed and inconclusive. Over time, like drought other weather-related disasters may erode the social and economic bases on which farming communities depend. Rural vulnerability to mental health problems is greatly increased by socioeconomic disadvantage. Related factors may compound this, such as reduced access to health services as communities decline and a “stoical” culture that inhibits help-seeking. Australia has the world’s most variable climate and is a major global agricultural producer. Yet despite Australia’s (and, especially, rural communities’) dependence on farmers’ well-being and success, there is very little—and inconclusive—quantitative evidence about farmers’ mental health. The aim of this review is to consider, with a view to informing other countries, how climate change and related factors may affect farmers’ mental health in Australia. That information is a prerequisite to identifying, selecting, and evaluating adaptive strategies, to lessen the risks of adverse mental health outcomes. The authors identify the need for a systematic epidemiology of the mental health of farmers facing increasing climate change— related weather adversity.

Work demands, job insecurity and sickness absence from work. How productive is the new, flexible labour force?

Background: We investigate one aspect of productivity – sickness absence – and ask whether job insecurity and high work demands are associated with increased sickness absence and, if so, whether mental or physical health mediates this association. We further investigate if having control at work modifies these associations.

Drought as a mental health exposure.

The mental health impact of drought is poorly quantified and no previous research has demonstrated a relationship between distress and explicit environmentally based measures of drought. With continuing climate change, it is important to understand what drought is and how it may affect the mental health. We quantified drought in terms of duration and intensity of relative dryness and identified drought characteristics associated with poor mental health to evaluate any vulnerability in rural and urban communities. Our methods involved analysis of 100-year longitudinal records of monthly rainfall linked to one wave (2007-2008) of the Household, Income and Labour Dynamics in Australia Survey. Cluster analysis was used to characterise different patterns of dryness and linear regression analysis was used to examine associations with participant distress, as well as the moderating role of rural locality. The results showed that, during a seven-year period of major and widespread drought, one pattern of relative dryness (extreme cumulative number of months in drought culminating in a recent period of dryness lasting a year or more) was associated with increased distress for rural but not urban dwellers. The increase in distress was estimated to be 6.22%, based on 95% confidence intervals. Thus, we show that it is possible to quantitatively identify an association between patterns of drought and distress.

Mind, body, spirit: co-benefits for mental health from climate change adaptation and caring for country in remote Aboriginal Australian communities.

The evident and unresolved health disparity between Aboriginal and other Australians is testament to a history of systematic disenfranchisement. Stigma, lack of appropriate services and the expense of delivering services in remote settings make it impossible to adequately address mental health needs, including suicide, solely using a mainstream medical approach. Nor do mainstream approaches accommodate the relationship between Aboriginal health and connectedness to land, whether traditional or new land, remote or metropolitan. This review describes how caring-for-country projects on traditional lands in remote locations may provide a novel way to achieve the linked goals of climate change adaptation with co-benefits for social and emotional wellbeing.

Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study

Objectives To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Design Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Setting Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. Participants 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Main outcome measures Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Results Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium. Conclusions Compared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions.

Improving the mental health of rural New South Wales communities facing drought and other adversities

OBJECTIVE NSW has just experienced its worst drought in a century. As years passed with insufficient rain, drought-related mental health problems became evident on farms. Our objective is to describe how, in response, the Rural Adversity Mental Health Program was introduced in 2007 to raise awareness of drought-related mental health needs and help address these needs in rural and remote NSW. The program has since expanded to include other forms of rural adversity, including recent floods. SETTING Rural NSW. DESIGN, PARTICIPANTS, INTERVENTIONS: Designed around community development principles, health, local service networks and partner agencies collaborated to promote mental health, education and early intervention. Strategies included raising mental health literacy, organising community social events and disseminating drought-related information. Priority areas were Aboriginal communities, older farmers, young people, women, primary health care and substance use. RESULTS Over 3000 people received mental health literacy training in the four years of operation from 2007 to 2010. Stakeholders collaborated to conduct hundreds of mental health-related events attended by thousands of people. A free rural mental health support telephone line provided crisis help and referral to rural mental health-related services. CONCLUSION Drought affected mental health in rural NSW. A community development model was accepted and considered effective in helping communities build capacity and resilience in the face of chronic drought-related hardship. Given the scale, complexity and significance of drought impacts and rural adjustment, and the threats posed by climate change, a long-term approach to funding such programs would be appropriate.

Could better jobs improve mental health? A prospective study of change in work conditions and mental health in mid-aged adults

Objectives To investigate the extent improvement or deterioration in employee job security, control or workload is associated with a change in mental health. Design Self-report panel data (2000, 2004) on mental health (symptoms of depression and generalised anxiety) and job demands, control and insecurity. Changes in exposures and outcomes were calculated by subtracting wave 1 from wave 2 scores. Changes in mental health were regressed onto changes in work conditions, adjusting for confounders. Sensitivity analyses assessed reverse causation, floor and ceiling effects. Setting Two adjoining cities in south-east Australia. Participants 1975 employees aged 40–48 years, 50% (n=995) male. Results Improvements and deterioration in each work condition were associated with corresponding improvements or deterioration in mental health. The association between changes in job insecurity and symptoms of depression was B=0.386 (95% CI 0.245 to 0.527) and with anxiety symptoms was B=0.434 (95% CI 0.267 to 0.601). Similarly, changes in job control were associated with changes in depressive (B=−0.548; 95% CI −0.791 to −0.304) and anxiety symptoms (B=−0.608; 95% CI −0.896 to −0.319) as were changes in job demands (B depression=0.386; 95% CI 0.245 to 0.527; B anxiety=0.434; 95% CI 0.267 to 0.601). Excluding people with severe symptoms at baseline did not alter the findings; however, path analyses indicated that depression may precede a worsening of work conditions. Conclusion Among mid-aged employees, deteriorating work conditions may amplify population health burdens, especially anxiety. Furthermore, better quality jobs, combining an array of positive conditions, could alleviate major population health burdens.

Pearl in the oyster: climate change as a mental health opportunity

Objective: Our world faces potentially catastrophic climate change and we have limited capacity to adapt to rapid or extreme climatic changes. As a result, we can expect significant adverse impacts on health. This includes mental health, a major and growing global concern. It is essential to understand how to respond quickly, effectively and within a manageable budget. The aim of this paper is to propose that the adverse consequences of climate change might offer a subtle but important mental health promotion opportunity which meets these criteria. Conclusions: Climate change will affect mental health directly through increasing exposure to trauma, and indirectly through harming physical health and damaging the physical environment on which economic opportunity depends. Disadvantaged people and communities, especially in rural and remote Australia, will be hardest hit. Seminal work by Alexander Leighton demonstrated how profound disadvantage and associated elevated psychiatric morbidity could be addressed by building community capacity. His methods might be adapted, using the need to address adverse climate change as an opportunity to build social capital. Social capital is associated with a wide range of socioeconomic and health advantages, particularly decreased psychiatric morbidity.