Table 1.

Monitoring and Measuring the Climate Change Impacts to Mental Health.

Climate Hazard	Populations of Concern	Potential Mental Health Outcomes	Indicators and Measurement Tools
Extreme Heat	People with pre-existing mental health conditions. People taking psychotropic medications that affect thermoregulation. Elderly (who have poor thermoregulation). People with substance abuse problems People living in urban heat islands Urban poor without access to air conditioning Those living on the street Outdoor laborers	Exacerbated mood or behavioral disorders Violence Aggression Suicide Other	Monitor emergency department visits after heat waves for an increase in patients reporting mood or behavioral disorders. Monitoring mortality statistics following extreme heat events—look for co-morbidities related to mental health and incidents of suicide. Interviews or questionnaires with people who experienced heat waves or extreme heat events to ask about their mental health in relation to heat events. Review of police records following extreme heat events to monitor elevated incidents of violence or aggression.
Extreme Weather Event (flood, hurricane, drought, mudslides, etc.)	Gender (Female) Sex (Female, particularly pregnant women) Age (children, infants, seniors) Race and ethnicity (non-Caucasian, non-white) Immigrants People with pre-existing health conditions People with low-socioeconomic status The under and non-insured (health care and home insurance) The under-housed and homeless Outdoor laborers First responders	Post-traumatic stress disorder (PTSD) Depression (including major depressive disorders) Anxiety Suicidal ideation Aggression Substance abuse and addiction Violence Survivor guilt Vicarious trauma Altruism Compassion Post-traumatic growth Other	Surveys Self-report surveys of general health. Consider using: - General Health Questionnaire (GHQ) Self-report surveys of mental illness and mental problems. Consider using any, or a combination of: - Disaster-PAST [61]; the Generalized Anxiety Disorder Scale (GAD-7); the Post-Traumatic Stress Disorder Checklist (PCL); The Center for Epidemiologic Studies Depression Scale (CES-D); the Kessler Psychological Distress Scale (K6) Self-report surveys of affirmative mental health. Consider using: - Stress-Related Growth Scale (SRGS); Post-Traumatic Growth Index (PTGI); Benefit Finding Scale (BFS) Patient Records Monitor emergency department visits after extreme weather events for an increase in patients reporting mental health problems or illness. Review of new prescription use for mental health and behavioral disorders after an extreme weather event Interviews - Interviews with primary care physicians and mental health care providers about any surges in patients reporting mental health issues following extreme weather events. - Interviews with people who experienced an extreme weather event about their perceptions regarding their mental health related to the extreme weather event.
Vector-borne disease (VBD) (e.g., Lyme Disease, West Nile Virus, Ticks)	Homeless People with pre-existing mental health conditions Outdoor workers	VBD disease (particularly: Lyme Disease or West Nile Virus) and compounded mental health problems (e.g., cognitive or neurological impairment, behavioral disorders)	Interviews or questionnaires with patients who have been diagnosed with VBDs to ask about perceptions of their mental health. Interviews with primary care physicians and mental health care providers about any mental health co-morbidities for patients diagnosed with VBDs.
Sea-Level Rise or Melting Permafrost	People who work or live near the ocean (sea-level rise) or in the arctic Outdoor laborers Indigenous people	Anxiety, worry, or fear of displacement Anxiety, worry, or fear of job loss Loss of place (grief, solace)	Interviews or questionnaires with residents who have or are experiencing sea-level rise or prolonged drought in their communities. Interview questions may focus on the mental health implications of: displacement, job loss associated with sea-level rise, infrastructure damage, agricultural or resource loss and resource scarcity, food and water safety and security.
Climate Change writ large (i.e., awareness of climate change threats to human and planetary health and survival)	People at greater risk from and exposure to climate change Researchers investigating climate change Environmental and climate change activists Environmental studies students Outdoor recreationalists Indigenous peoples	Anxiety Worry Stress Fear	Interviews or questionnaires with people who experience concern, anxiety, worry, related to awareness of climate change threats. The Generalized Anxiety Disorder Scale (GAD-7)