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ANZJP Correspondence
Climate change and mental disorders Scott Henderson1 and Roger Mulder2 1National
Institute for Mental Health Research, The Australian National University, Canberra, ACT, Australia 2Department of Psychological Medicine, University of Otago – Christchurch, Christchurch, New Zealand Corresponding author: Scott Henderson, National Institute for Mental Health Research, The Australian National University, Canberra, ACT 0200, Australia. Email: [email protected] DOI: 10.1177/0004867415610639
Climate change, the reality of which is fully accepted by the present authors, will inevitably have an impact on mental health in the affected communities. But does this justify the anxious anticipation of a major threat to the mental health of nations? One way in which epidemiology can contribute to this issue is to clarify the magnitude of the expected morbidity and its administrative significance for services. Such information can provide a basis for action. Here, we consider three categories of variable. First are the environmental events that climate change is believed to promote. Floods, tsunamis, droughts, heat waves, cyclones and wildfire must each carry substantial threat to the mental health of those exposed. Some events will be acute, a few long-lasting, while there is the additional likelihood of multiple exposures to one or more event in the same population. Second are those groups who will be particularly at risk since the health impact is likely to be non-random. The third category is the nature of the psychopathology likely to be induced and its expected course, short- and long-term. In considering this, it is important to bear in mind that the need to adapt to extreme adversity is not new in the history of human evolution. A sizeable literature has already accumulated on climate change and mental health, but only some of it carries
quantitative data. More common are calls to action without clear evidence for an increase in prevalence in the general population. Clearly, adverse climatic events will be followed by an increase, within the affected communities, in distress, grief reactions, depression and anxiety disorders including post-traumatic stress disorder (PTSD) and a small rise in suicide rates. In a comprehensive review of the psychological impacts of global climate change, Doherty and Clayton (2011) add evidence for increased violence with increased ambient temperature, inter-group conflict in the face of diminished resources and emotional reactions to forced relocation. Many authors point to the particular vulnerability of groups living in poverty or already in impaired health including mental disorders. So far, little has been written about effects on infants and children or the very elderly. However, McDermott et al. (2014) reported that 1 in 5 children and 1 in 12 adolescents endorsed cyclone-related PTSD symptoms 18 months after the Queensland cyclone. Spittlehouse et al. (2014) noted that 18 months after the Christchurch earthquake, rates of major depression were higher and social functioning scores significantly lower in middle-aged persons than similar population norms. What are the implications of the available information for mental health at the national level? The magnitude of the overall impact, expressed as an increase in annual prevalence for a nation, is unlikely to be great. Administratively, in those countries with developed mental health services, only a proportion of those who develop symptoms will seek or obtain psychotherapy and on occasion medication. Such a peak in service demand is likely to be transient. The impact on mental health and social distress will not be as bad as that caused by, for example, the mass movement of refugees in Europe, the current and ubiquitous Ice (methylamphetamine) epidemic, domestic violence or abuse in childhood. Indeed, there is so far little evidence to justify
climate change being given priority above other threats to mental health. That apart, one hypothesis not yet proposed is that an increase in global temperature might have neurobiological sequelae, including an influence on the foetal brain. There are some counter-intuitive consequences of disasters or other extreme environmental adversity. They can be associated with an increase in social capital through the emergence of previously absent mutual support. This was seen in the London Blitz and more recently in the Christchurch earthquake, where some study participants reported a strengthening of social and family relationships with increased resilience (Fergusson et al., 2015). Remarkably, a dose–response association was also found, with increasing exposure being followed by increased resilience. While the relative risk of suicide increased in men during drought in New South Wales (NSW) during 1970–2007, it decreased in women. One interpretation was that women particularly benefit from increased community supports. In his magisterial examination of the place of social capital in relation to climate change, Adger (2001) points out that in the past 10,000 years of human history, it may have been climate changes which provided the impetus for altering the way resources are managed. In summary, when it is proposed that climate change presents a potential threat to world mental health, we recommend that data be acquired to support this, thereby allowing an appropriate response to be formulated. Declaration of interest The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship and/or publication of this article.
Australian & New Zealand Journal of Psychiatry, 49(11)
Downloaded from anp.sagepub.com at Middle East Technical Univ on January 14, 2016
1062
See Research by Ferguson et al., 49(4): 351–359.
References Adger WN (2001) Social capital and climate change. Working paper no 8. Tyndall Centre for Climate Change Research. Available at: www. researchgate.net/publication/228386024
Commentary on Black et al., a systematic review: Identifying the prevalence rates of psychiatric disorder in Australia’s Indigenous populations Michael Wright1,2, Ashleigh Lin2 and Margaret O’Connell2 1National
Drug Research Institute, Curtin University, Perth, WA, Australia 2Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia Corresponding author: Michael Wright, National Drug Research Institute, Curtin University, PO Box U1987, Perth WA 6845, Australia Email: [email protected] DOI: 10.1177/0004867415604370
The recent systematic review by Black et al. (2015) highlights a number of issues regarding the state of research on mental illness in Aboriginal and Torres Strait Islander Australians. The dismally low number of papers identified by Black et al. points to the fact that little research has been conducted in the area. The review reveals the need for both culturally competent validation of diagnostic tools and more consistent methodological approaches to prevalence studies conducted in Aboriginal communities. However, more pressingly, there is a need for greater critique of the theoretical frameworks underpinning programme evaluations. Revisiting these frameworks may offer new ways of engaging and working with Aboriginal communities to shape understandings of mental illness experienced by Aboriginal peoples.
ANZJP Correspondence Doherty TJ and Clayton S (2011) The psychological impacts of global climate change. American Psychologist 66: 265–276. Fergusson DM, Boden JM, Horwood LJ, et al. (2015) Perceptions of distress and positive consequences following exposure to a major disaster amongst a well-studied cohort. Australian and New Zealand Journal of Psychiatry 49: 351–359.
McDermott B, Cobham V, Berry H, et al. (2014) Correlates of persisting posttraumatic symptoms in children and adolescents 18 months after a cyclone disaster. Australian and New Zealand Journal of Psychiatry 48: 80–86. Spittlehouse JK, Joyce PR, Vierck E, et al. (2014) Ongoing adverse mental health impact of the earthquake sequence in Christchurch, New Zealand. Australian and New Zealand Journal of Psychiatry 48: 756–763.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) are Western classification systems, and the transferability of these criteria into Aboriginal contexts is questionable. Professor Arthur Kleinman, noted Harvard academic, reminds us that classifications systems such as these are a guide to be used with caution. Clinicians should always utilise the resources available to them, and first and foremost, they should always apply the principle of do no harm. In particular, culture should never be underestimated or ignored in determining the presence and severity of mental illness. Alex Brown’s work (Brown et al. 2013), for example, goes some way to validating diagnostic instruments in partnership with Aboriginal communities and opens up a new landscape in which to investigate the nosological challenges faced by psychiatry. If we are to view research as a means to an end, we must begin our questions at their source; the origins from which we formulate our research questions represent the worldviews with which we see and experience the world around us. The suggestion made by Black et al. that the Australian Bureau of Statistics (ABS) Australian Health Survey (AHS) scheduled for 2018 incorporate questions relating to mental health in addition to physical health is in itself a valid one. However, it does not necessarily further our understanding of the cultural perspectives inherent in Aboriginal peoples’ experiences of and understandings about mental illness, particularly given the diversity of Aboriginal peoples in Australia.
The Looking Forward Aboriginal Mental Health Project undertaken in Perth, Western Australia (Wright et al., 2013a, 2013b; Wright and O’Connell, 2015) further attempts to address this very question. How can we bring about systems change through a better understanding and acknowledgement of Aboriginal worldviews in relation to the ways in which Aboriginal clients and their families access mental health services? And how can service providers more effectively respond to Aboriginal clients and their families with greater attention to the cultural and spiritual dimensions of their lives? The Project seeks to develop ways for services to engage with Aboriginal people by bringing them together with local Elders to create new ways of working in collaboration with the local Aboriginal community in the Perth metropolitan area. For mental health and drug and alcohol service providers, developing a working understanding of a Nyoongar1 worldview is central to the change efforts they undertake alongside the community. We believe that the Looking Forward Project is a direct challenge to the mental health system, not by researchers but by the participants, that is, Nyoongar Elders and service providers, together. We are very confident that change will occur, for we are witnessing such change emerging in the governance and practices of these organisations. What has become clear in our work is that attempting to fit Aboriginal worldviews and experiences of mental illness into the mainstream system is unlikely to be successful. This approach is itself a contributing factor that excludes Aboriginal peoples from
Australian & New Zealand Journal of Psychiatry, 49(11) Downloaded from anp.sagepub.com at Middle East Technical Univ on January 14, 2016
ANZJP Correspondence
Climate change and mental disorders Scott Henderson1 and Roger Mulder2 1National
Institute for Mental Health Research, The Australian National University, Canberra, ACT, Australia 2Department of Psychological Medicine, University of Otago – Christchurch, Christchurch, New Zealand Corresponding author: Scott Henderson, National Institute for Mental Health Research, The Australian National University, Canberra, ACT 0200, Australia. Email: [email protected] DOI: 10.1177/0004867415610639
Climate change, the reality of which is fully accepted by the present authors, will inevitably have an impact on mental health in the affected communities. But does this justify the anxious anticipation of a major threat to the mental health of nations? One way in which epidemiology can contribute to this issue is to clarify the magnitude of the expected morbidity and its administrative significance for services. Such information can provide a basis for action. Here, we consider three categories of variable. First are the environmental events that climate change is believed to promote. Floods, tsunamis, droughts, heat waves, cyclones and wildfire must each carry substantial threat to the mental health of those exposed. Some events will be acute, a few long-lasting, while there is the additional likelihood of multiple exposures to one or more event in the same population. Second are those groups who will be particularly at risk since the health impact is likely to be non-random. The third category is the nature of the psychopathology likely to be induced and its expected course, short- and long-term. In considering this, it is important to bear in mind that the need to adapt to extreme adversity is not new in the history of human evolution. A sizeable literature has already accumulated on climate change and mental health, but only some of it carries
quantitative data. More common are calls to action without clear evidence for an increase in prevalence in the general population. Clearly, adverse climatic events will be followed by an increase, within the affected communities, in distress, grief reactions, depression and anxiety disorders including post-traumatic stress disorder (PTSD) and a small rise in suicide rates. In a comprehensive review of the psychological impacts of global climate change, Doherty and Clayton (2011) add evidence for increased violence with increased ambient temperature, inter-group conflict in the face of diminished resources and emotional reactions to forced relocation. Many authors point to the particular vulnerability of groups living in poverty or already in impaired health including mental disorders. So far, little has been written about effects on infants and children or the very elderly. However, McDermott et al. (2014) reported that 1 in 5 children and 1 in 12 adolescents endorsed cyclone-related PTSD symptoms 18 months after the Queensland cyclone. Spittlehouse et al. (2014) noted that 18 months after the Christchurch earthquake, rates of major depression were higher and social functioning scores significantly lower in middle-aged persons than similar population norms. What are the implications of the available information for mental health at the national level? The magnitude of the overall impact, expressed as an increase in annual prevalence for a nation, is unlikely to be great. Administratively, in those countries with developed mental health services, only a proportion of those who develop symptoms will seek or obtain psychotherapy and on occasion medication. Such a peak in service demand is likely to be transient. The impact on mental health and social distress will not be as bad as that caused by, for example, the mass movement of refugees in Europe, the current and ubiquitous Ice (methylamphetamine) epidemic, domestic violence or abuse in childhood. Indeed, there is so far little evidence to justify
climate change being given priority above other threats to mental health. That apart, one hypothesis not yet proposed is that an increase in global temperature might have neurobiological sequelae, including an influence on the foetal brain. There are some counter-intuitive consequences of disasters or other extreme environmental adversity. They can be associated with an increase in social capital through the emergence of previously absent mutual support. This was seen in the London Blitz and more recently in the Christchurch earthquake, where some study participants reported a strengthening of social and family relationships with increased resilience (Fergusson et al., 2015). Remarkably, a dose–response association was also found, with increasing exposure being followed by increased resilience. While the relative risk of suicide increased in men during drought in New South Wales (NSW) during 1970–2007, it decreased in women. One interpretation was that women particularly benefit from increased community supports. In his magisterial examination of the place of social capital in relation to climate change, Adger (2001) points out that in the past 10,000 years of human history, it may have been climate changes which provided the impetus for altering the way resources are managed. In summary, when it is proposed that climate change presents a potential threat to world mental health, we recommend that data be acquired to support this, thereby allowing an appropriate response to be formulated. Declaration of interest The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.
Funding The author(s) received no financial support for the research, authorship and/or publication of this article.
Australian & New Zealand Journal of Psychiatry, 49(11)
Downloaded from anp.sagepub.com at Middle East Technical Univ on January 14, 2016
1062
See Research by Ferguson et al., 49(4): 351–359.
References Adger WN (2001) Social capital and climate change. Working paper no 8. Tyndall Centre for Climate Change Research. Available at: www. researchgate.net/publication/228386024
Commentary on Black et al., a systematic review: Identifying the prevalence rates of psychiatric disorder in Australia’s Indigenous populations Michael Wright1,2, Ashleigh Lin2 and Margaret O’Connell2 1National
Drug Research Institute, Curtin University, Perth, WA, Australia 2Telethon Kids Institute, The University of Western Australia, Subiaco, WA, Australia Corresponding author: Michael Wright, National Drug Research Institute, Curtin University, PO Box U1987, Perth WA 6845, Australia Email: [email protected] DOI: 10.1177/0004867415604370
The recent systematic review by Black et al. (2015) highlights a number of issues regarding the state of research on mental illness in Aboriginal and Torres Strait Islander Australians. The dismally low number of papers identified by Black et al. points to the fact that little research has been conducted in the area. The review reveals the need for both culturally competent validation of diagnostic tools and more consistent methodological approaches to prevalence studies conducted in Aboriginal communities. However, more pressingly, there is a need for greater critique of the theoretical frameworks underpinning programme evaluations. Revisiting these frameworks may offer new ways of engaging and working with Aboriginal communities to shape understandings of mental illness experienced by Aboriginal peoples.
ANZJP Correspondence Doherty TJ and Clayton S (2011) The psychological impacts of global climate change. American Psychologist 66: 265–276. Fergusson DM, Boden JM, Horwood LJ, et al. (2015) Perceptions of distress and positive consequences following exposure to a major disaster amongst a well-studied cohort. Australian and New Zealand Journal of Psychiatry 49: 351–359.
McDermott B, Cobham V, Berry H, et al. (2014) Correlates of persisting posttraumatic symptoms in children and adolescents 18 months after a cyclone disaster. Australian and New Zealand Journal of Psychiatry 48: 80–86. Spittlehouse JK, Joyce PR, Vierck E, et al. (2014) Ongoing adverse mental health impact of the earthquake sequence in Christchurch, New Zealand. Australian and New Zealand Journal of Psychiatry 48: 756–763.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) are Western classification systems, and the transferability of these criteria into Aboriginal contexts is questionable. Professor Arthur Kleinman, noted Harvard academic, reminds us that classifications systems such as these are a guide to be used with caution. Clinicians should always utilise the resources available to them, and first and foremost, they should always apply the principle of do no harm. In particular, culture should never be underestimated or ignored in determining the presence and severity of mental illness. Alex Brown’s work (Brown et al. 2013), for example, goes some way to validating diagnostic instruments in partnership with Aboriginal communities and opens up a new landscape in which to investigate the nosological challenges faced by psychiatry. If we are to view research as a means to an end, we must begin our questions at their source; the origins from which we formulate our research questions represent the worldviews with which we see and experience the world around us. The suggestion made by Black et al. that the Australian Bureau of Statistics (ABS) Australian Health Survey (AHS) scheduled for 2018 incorporate questions relating to mental health in addition to physical health is in itself a valid one. However, it does not necessarily further our understanding of the cultural perspectives inherent in Aboriginal peoples’ experiences of and understandings about mental illness, particularly given the diversity of Aboriginal peoples in Australia.
The Looking Forward Aboriginal Mental Health Project undertaken in Perth, Western Australia (Wright et al., 2013a, 2013b; Wright and O’Connell, 2015) further attempts to address this very question. How can we bring about systems change through a better understanding and acknowledgement of Aboriginal worldviews in relation to the ways in which Aboriginal clients and their families access mental health services? And how can service providers more effectively respond to Aboriginal clients and their families with greater attention to the cultural and spiritual dimensions of their lives? The Project seeks to develop ways for services to engage with Aboriginal people by bringing them together with local Elders to create new ways of working in collaboration with the local Aboriginal community in the Perth metropolitan area. For mental health and drug and alcohol service providers, developing a working understanding of a Nyoongar1 worldview is central to the change efforts they undertake alongside the community. We believe that the Looking Forward Project is a direct challenge to the mental health system, not by researchers but by the participants, that is, Nyoongar Elders and service providers, together. We are very confident that change will occur, for we are witnessing such change emerging in the governance and practices of these organisations. What has become clear in our work is that attempting to fit Aboriginal worldviews and experiences of mental illness into the mainstream system is unlikely to be successful. This approach is itself a contributing factor that excludes Aboriginal peoples from
Australian & New Zealand Journal of Psychiatry, 49(11) Downloaded from anp.sagepub.com at Middle East Technical Univ on January 14, 2016
