Geopsychiatry: Climate change, migration, and mental health

Abstract

Geopsychiatry, a newly emerging discipline within psychiatry, examines the influence of geopolitical determinants on mental health and mental illness. Geopolitical determinants include conflict and wars, global austerity, climate change, public health crises (such as the coronavirus disease 2019 (COVID-19)), and migration. This study focuses on the two significant areas of climate change and migration. Climate change can affect mental health directly or indirectly in a variety of ways, including chronic (global warming) and acute (heat waves and environmental disasters) events. Certain groups of migrants, including migrating children, older migrants, refugees, and asylum seekers, are particularly vulnerable to developing psychiatric disorders. The convergence of climate change and migration is significantly complicating the already highly difficult situation for mental health services worldwide, particularly in low- and middle-income countries where access to care is limited. Despite this, the majority of studies examining mental health impacts of these events originate from high-income countries, and there is still a lack of effective preventive and treatment strategies. In 2023, the World Psychiatric Association (WPA) set up a Special Interest Group on Geopsychiatry with a clear and explicit aim to summarize current evidence and propose strategies to tackle geopolitical challenges on mental health. The Special Interest Group aims to support regional and local groups across all psychiatric disciplines and stakeholders dedicated to building local consensus, prioritizing research, crafting policies, and collating and sharing good clinical practices. With such significant effort, we can expand our understanding and collaboration on geopsychiatry and make changes to the care of people with geopolitical and mental health challenges around the globe.

Of late, there has been an increasing interest in the field of geopsychiatry—a newly emerging discipline within psychiatry. Geopsychiatry aims to look at the influence of geopolitical determinants on mental health and mental illness.[1] These geopolitical factors may influence mental health and well-being directly through manmade or natural acts, including wars, conflicts, and terrorism, leading to migration within the borders of a country or across international borders. These factors affect mental health indirectly through their impact on social determinants and other factors.

Geopolitical determinants may be viewed as a system of relationships among assets and processes linking communities at a one-step higher level of organization than the level of the community or neighborhood.[2] Geopolitical determinants, especially in the context of conflict and wars, can lead to human rights violations. Other geopolitical factors, including regional conflict, global austerity, climate change, public health crises (such as COVID-19), and transnational migration, influence mental health and well-being of migrants but also that of people left behind, and in the face of a new community, there may be additional pressures on migrants, refugees, and asylum seekers. These emerging and fast-changing challenges are transforming the cultural and historical architecture of communities. It is well recognized that the incidence and prevalence rates of several psychiatric disorders are higher in certain migrant groups when compared to local populations. The causes of these increases are many and need further teasing out in the context of globalization and global interconnectedness. One of the explanations for the increase in rates of post-traumatic stress disorders, depression, etc., is that post-traumatic stress disorder and depression have been related to previous collective trauma.[2] However, the impact of current geopolitical changes on mental health and the appropriate responses are still poorly understood. Toward this end, the World Psychiatric Association (WPA) in 2023 set up a Special Interest Group on Geopsychiatry with a clear and explicit aim to summarize current evidence and propose strategies to tackle geopolitical challenges on mental health. This study focuses on the two significant areas of climate change and migration.

Climate change and mental health

Climate change can affect mental health directly or indirectly in a variety of ways, including chronic (global warming) and acute (heat waves and environmental disasters) events. The consequences of climate change are distributed unevenly, with specific groups experiencing a disproportionate impact due to various compounding geopolitical factors. Research on global warming has revealed that a rise of 1 degree Celsius in ambient temperature is linked to a 2.2% surge in mental health mortality, encompassing organic mental disorders, suicide, and self-harm. Additionally, there is a 0.9% increase in mental health morbidity, particularly concerning mood and anxiety disorders, as well as schizophrenia.[3]

Experiencing environmental disasters such as flooding or storms has been associated with a higher occurrence of depression, post-traumatic stress disorder, and various anxiety disorders. Among the vulnerable groups, both the younger and older populations have been identified as particularly susceptible. Moreover, women are more prone to experiencing depression, anxiety, and stress-related disorders, while men exhibit a higher likelihood of death by suicide.[4] Other vulnerable groups, such as those with intellectual disabilities or lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ)+ populations, have specific issues related to vulnerability. In many countries, stigma against these vulnerable groups further causes additional problems.

Ecological anxiety or grief has recently been the focus of new studies.[5] It is characterized by stress or apprehension caused by the anticipation of environmental changes or current losses, respectively. Children, adolescents, and people whose economic activities or culture are strongly tied to the land seem to suffer the most from mental health impacts. Furthermore, individuals with limited access to mental health care tend to experience more acute forms of ecological anxiety or grief.[5]

Finally, lifestyle and social-economic factors associated with mental health can also be threatened by extreme weather conditions. Difficulty accessing healthy food or, in more serious cases, food insecurity has been reported as one of the consequences of climate-related impacts on agriculture. Furthermore, livelihood shortages force many to leave their land and migrate elsewhere.[4]

Migration and mental health

Migration involves the relocation of individuals from their typical geographic location to another, which can occur either within a country (such as moving between rural and urban areas) or across international borders, either temporarily or permanently. A significant number of migrants resort to irregular migration processes, putting them at risk of human trafficking, illegal occupation, sexual and physical violence, and life-threatening situations. People may choose to migrate or be forced to migrate for a number of reasons. The most prominent of these are political reasons. Economic and educational reasons also play an important role in leading to voluntary migration.

Before their departure, many migrants may witness or have direct traumatic experiences involving poor living conditions and situational unrest in their homeland.[6] They may also feel frustrated by lengthy and complicated application processes for migration. Upon arrival, many migrants often find themselves compelled to undergo a process known as “acculturation,” wherein they may need to partially or completely relinquish their original culture and embrace the new one. However, this acculturation process can be impeded by various forms of discrimination, including those based on factors such as race, religious beliefs, and gender.[7]

It is not uncommon for migrants to face inadequate protection in terms of occupational safety and social care benefits. Additionally, they may encounter difficulties accessing standard educational programs and healthcare services. These stressors lead to an increased risk of psychiatric disorders among migrants, including schizophrenia and psychotic disorders, depression, substance use disorder, and self-harm and suicidal attempts.

As highlighted earlier, specific migrant groups are particularly susceptible to developing psychiatric disorders. In the context of detention, migrating children, in particular, may experience trauma due to the distressing experience of being separated from their parents.[8] The interruption or cessation of their education may happen needlessly. Diagnosing dementia in older migrants proves challenging due to language barriers and cultural influences impacting the suitability of cognitive assessments. Changes in societal norms contribute to an increased number of women migrating as secondary migrants and entering the workforce. Nonetheless, some women may find themselves coerced into sex trafficking without sufficient protection. Refugees and asylum seekers might experience frustration with the protracted asylum process, coupled with feelings of anxiety and guilt about leaving their families behind.

Mental health consequences stemming from the interplay of climate change and migration

The precise measurement of the physical and mental health consequences stemming from the interplay of climate change and migration is not well established. However, it is clear that countries in the Global South bear a disproportionate burden, facing heightened environmental challenges and limited coping resources. Importantly, the majority of research on mental health effects of these occurrences originates from affluent nations, revealing a deficiency in both preventive approaches and treatment strategies.[3]

Importantly, it is often the case that when an entire community is affected, the availability of social support can be compromised, increasing the need for appropriate government responses. However, the effects of climate change and migration are further complicating the already highly demanding landscape for mental health and mental health services worldwide. This is particularly pronounced in low- and middle-income countries, where access to care is more limited, and the existing services are strained under significant pressure.

Recommendations

In view of the impending threats, we emphasize the urgent requirement to include mental health considerations in the framework of efforts addressing climate change and migration. However, although increased attention has been given to the health consequences of geopolitical factors, mental health issues are often not considered. Therefore, this Special Interest Group aims to promote knowledge in the following areas: 1) Effects of climate change on a wider diversity of cultures, populations, and geographic regions; 2) cultural, genetic, and geographical (such as language) factors associated with symptom manifestation and treatment response, accessibility (e.g. through the availability of interpreters), and adherence among immigrants; 3) training of professionals working in the care of populations affected by climate change or migration; and 4) an evidence-based approach to monitor, prevent, and manage mental health issues on these populations.

More broadly, this Special Interest Group also aims to develop various action plans. Several Centres for Geopsychiatry across all zones have been established. These include Cairo, Manila, Kolkata, Brasilia, Cagliari, and San Lorenzo in Paraguay, and other places are being considered. These centers will facilitate the coordination of research, policy development, and training for various health professionals. Their aim is to incorporate evidence related to climate change and other geopolitical factors into their practices. The Special Interest Group aims to support regional and local groups across all psychiatric disciplines and stakeholders dedicated to building local consensus, prioritizing research, crafting policies, and collating and sharing good clinical practices. It is crucial to raise awareness, acceptance, and prioritization of geopsychiatry in global and national health policies. Building on increasingly interesting work on existing data on geopolitical determinants, it is crucial to build a repository of information on existing evidence to inform research, policy, clinical practice, and advocacy for better outcomes.

As a group, we would like to invite interested individuals and institutions to promote equity in mental health care for persons of different ages, gender, race or ethnicity, religion, and socioeconomic status.[9] With such significant capacity and responsibility, we can expand our understanding and collaboration on geopsychiatry and make changes to the care of people with geopolitical and mental health crises around the globe.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.