Extreme weather events and pathways to mental health outcomes in sub-Saharan Africa: A systematic review

Abstract

Climate change has led to more frequent and intense extreme weather events (EWEs) globally, with sub-Saharan Africa (SSA) being disproportionately affected. Given the region’s socioeconomic vulnerability and strong reliance on agriculture for subsistence, EWEs have the potential to affect the local population’s mental health. The present systematic review synthesizes evidence on the impacts of EWEs on mental health in SSA, examining moderators and the pathways by which EWEs affect mental health, and identifying particularly vulnerable populations. In accordance with the PRISMA guidelines, we searched the PubMed, PsycINFO, and Web of Science databases and grey literature sources for relevant publications up to June 2024. Of the 3242 initially identified articles, 15 peer-reviewed journal articles from seven countries met the inclusion criteria. Studies examined floods (n = 8), droughts (n = 7), and heavy rainfall (n = 1) as EWEs, and reported psychological distress, anxiety, depression, and post-traumatic stress disorder (PTSD) as mental health outcomes. Findings indicate that EWEs affect mental health through both direct pathways, reflecting immediate psychological trauma from exposure, and indirect pathways, operating through displacement, economic instability, and water and food insecurity. Moderators included protective factors such as social support and religion, as well as risk factors such as being an adolescent, being female, and being economically disadvantaged. There were few longitudinal studies, a limited examination of heatwaves, and a lack of culturally sensitive strategies for mental health support, indicating evidence gaps. As the incidence of EWEs increases across SSA, there is an urgent need for expanded research, improved health systems, and targeted interventions for vulnerable populations.

1. Introduction

Extreme weather events (EWEs) resulting from climate change (IPCC, 2022) pose significant threats to human health – both directly and indirectly – with particular concern for mental health outcomes (IPCC, 2022; Bolan et al., 2024). Nevertheless, mental health is among the least-studied areas in climate and health research (Berrang-Ford et al., 2021). Evidence suggests that the link between EWEs and human mental health operates through multiple interconnected pathways, including economic strain, social isolation, and environmental disruption (Ebi et al., 2021; Cianconi et al., 2020; Berry et al., 2018; Vins et al., 2015). These outcomes are particularly alarming in regions with various vulnerabilities and inadequate disaster mitigation systems. Population vulnerability as framed by the Intergovernmental Panel on Climate Change (IPCC) (IPCC, 2022) incorporates three key elements: (i) exposure risk to extreme events, (ii) pre-existing vulnerabilities within communities, and (iii) capacity to cope with and recover from the resulting damage.

Evidence shows that EWEs affect health by directly and indirectly increasing illness burden and changing healthcare usage patterns. A global review of 59 studies conducted between 1980 and 2020 found that exposure to EWEs was associated with significant mental health impacts: exposed individuals commonly experienced elevated levels of depression, post-traumatic stress, and anxiety, with depression emerging as the most frequently reported outcome (Chique et al., 2021). Overall, people exposed to extreme weather are more likely to experience psychological impairment compared to those who are not exposed to extreme weather. Higher psychological impairment risk was found among women, those with greater exposure, individuals with pre-existing mental health issues, individuals from lower socioeconomic status, and rural populations. Impacts were highest in the post-event period and in areas with repeated exposure (Chique et al., 2021). There is a strong link between climate-related events and mental health outcomes, including anxiety, depression, post-traumatic stress disorder (PTSD), and increased suicide risk, with effects ranging from acute to long-term, particularly among the economically unstable and displaced (Cianconi et al., 2020). The vulnerable, including children and older adults, are most affected (Cianconi et al., 2020). In developing countries (Asia and the Americas), increased psychological illnesses from EWEs were recorded (Rataj et al., 2016). Risk factors for anxiety, depression, and PTSD include poor health, high exposure to trauma, prior traumatic experiences, female sex, home destruction, and witnessing deaths. However, current evidence is heavily skewed toward the Global North, with limited representation from the Global South, specifically SSA.

Despite contributing to less than 2% of global cumulative greenhouse gas emissions, SSA faces a disproportionate exposure to EWEs, including heat waves, bearing some of the most severe consequences of global climate change (Prospects, 2023; World Metrological Organization, 2023; Ritchie, 2023). Over the past decades, at least 46 countries in SSA have experienced unprecedented floods, droughts, storms, and landslides (Ayanlade et al., 2022), with the IPCC confidently projecting a continued increase in such events in the region in the coming years (IPCC, 2022). The vulnerability of populations in the Global South to climate-related mental health impacts is exacerbated by several intersecting factors, including socioeconomic disparities, unequal power relations, governance challenges, and limited mitigation and adaptation capabilities (Ngcamu, 2023). Rising temperatures, increasing droughts, and declining water availability, which threaten human health, food security, and biodiversity, increase susceptibility towards infectious diseases, malnutrition, and mental health problems (United Nations Climate Change Convention, 2006; Centre for Research on the Epidemiology of Disasters (CRED), 2020). SSA is at higher risk compared to Northern Africa due to its heavy reliance on rain-fed agriculture, limited capacity to adapt, widespread poverty, and inadequate infrastructure to handle EWEs. In contrast, Northern Africa typically boasts a more diversified economy and a greater ability to manage these extremes thanks to the use of irrigation systems and technology (Ayanlade et al., 2022; Omotoso et al., 2023).

Though related research is geographically limited, a review by Deglon et al. (Deglon et al., 2023) examined the adverse mental health outcomes associated with EWEs in Africa. From 12 studies, Deglon et al. found strong associations of EWEs with mental disorders and psychological distress. The review reports that floods were primarily correlated with PTSD and depression; droughts with chronic stress and suicide risk among farmers; and extreme heat with aggression and suicide, particularly in women. These impacts were intensified by social inequalities, affecting women with caregiving duties, youth experiencing eco-anxiety, and farmers facing livelihood loss. Another review by Rother et al. (Rother et al., 2022) focuses on children and adolescents. It finds that EWEs threaten mental health by causing anxiety, depression, and PTSD, intensified by poverty, displacement, and disrupted access to services. Additional evidence indicated direct mental health effects from EWEs, and indirect effects from livelihood loss and community instability, manifested as distress and impaired functioning (Rother et al., 2022). While children are especially vulnerable due to their developmental stage and limited coping resources, protective factors like age, sex, and shared hardship were identified (Rother et al., 2022).

This complex interplay of the aforementioned factors positions SSA populations at a particularly high risk of experiencing the mental health impacts of EWEs (Berry et al., 2018). Additionally, the relationship between EWEs and mental health in this region is potentialized by other factors, including systemic challenges in healthcare access and limited mental health resources (Cianconi et al., 2020; Wainberg et al., 2017). So far, little evidence has been generated in SSA on the relationship between EWEs and mental health. Yet, funding for climate-related mental health research accounts for only a small share of the global resources available for climate-related research (IPCC, 2022).

Building on the foundational work of Deglon et al. (Deglon et al., 2023), our systematic review employed narrative synthesis to explore and describe the mechanisms underlying the association between exposure to EWEs and adverse mental health outcomes in SSA populations. This review incorporates a systems-thinking framework to identify and analyze the complex network of interacting factors linking EWEs to mental health outcomes in this context. Systems thinking focuses on the interrelationships among parts and their connections to a functioning whole, often within the context of a larger system (Trochim et al., 2006; Peters, 2014). A systems-thinking framework offers a comprehensive approach to understanding complex problems by viewing them as interconnected wholes, emphasizing relationships and patterns rather than isolated components. Berry et al. argue that climate change’s mental health impacts are substantial but underestimated, as current research uses individual-level, short-term frameworks which inadequately capture the complex, multi-level pathways through which climate change affects mental health (Berry et al., 2018). In other climate-change related reviews (Iwuji et al., 2024; Orievulu et al., 2022), this approach acknowledges that our understanding of how EWEs affect mental health must consider not only individual-level factors but also broader societal, temporal, and environmental influences (Berry et al., 2018). This review emphasizes the evidence regarding the mental health impacts of EWEs in SSA. It also explores the relevant moderators and pathways with the aim of informing policymakers and guiding the development of targeted, integrated solutions to mitigate the effects of climate change on mental health.

2. Methods

Our review was registered on PROSPERO (PROSPERO, 2024) (CRD42024544422). The search, selection, quality assessment, and data synthesis were performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (Shamseer et al., 2015).

2.1. Search Strategy

Using appropriate keywords, we searched PubMed, PsycINFO, and the Web of Science databases in June 2024. The search strings were divided into three major groups: “mental health,” “extreme weather events,” and “sub-Saharan Africa.” All search terms and their combinations were separated using appropriate Boolean operators. Additionally, the reviewers manually checked the reference lists of the included articles, and the retrieved studies were subjected to the same selection criteria. Detailed search strings, including the terms used in each database, are provided in Appendix S1. Additionally, two reviewers (JFC and GNW) searched for grey literature on Google Scholar, the King’s College London Research Portal, OpenAIRE, the Heidelberg University Library, African Journals Online, and Global Index Medicus. However, no grey literature relevant to our review was identified (Table 1).

Table 1. Inclusion and exclusion criteria.

Inclusion criteria	Exclusion criteria
Literature and population –Peer-reviewed and original articles, as well as grey literature. –Quantitative and qualitative studies. –All countries from sub-Saharan Africa are included. –Age and sex groups with no limitation. –Languages: English, Portuguese, and French. –No time constraints. –Multi-site studies are included if a sub-Saharan African country is included.	–Full text not available. –Reviews (systematic, scoping, etc.) –The methodology is unclear (no methods were described, or they were poorly described). –Studies related to other biological species.
Extreme Weather Event (EWE) Exposures –Extreme weather events considered by IPCC 2021 to worsen due to climate change: heat waves, cyclones, storms, floods, droughts, extreme precipitation, and sea level rise. Each study author stated specific cut-offs.	–Results under the modelling of future climate change scenarios. –Heat (non-heatwave periods), cold spells, and geologic events (volcanoes, earthquakes).
Mental Health Outcomes –Articles that primarily analyze the effects of extreme weather events on mental health. –All mental health conditions are classified according to ICD-10, e.g., anxiety disorders, depression, etc. –Psychological distress (non-diagnosed symptomatology). –Morbidity (emergency department visits, hospital admissions, prevalence, etc.) and mortality.	–Non-specific outcomes of Positive Mental Health: happiness, resilience.

Once the titles were extracted from the three databases, duplicates were removed in EndNote (2024). The remaining titles were uploaded to Rayyan (2024), where screening and selection of relevant titles were performed. Three independent researchers (JFC, GNW, and FMW) reviewed the articles by title, and those considered for the next stage received a favourable vote from at least one reviewer. In the abstract and full-text selection stage, studies were included only if the majority – at least 2 of 3 reviewers – voted in favour. The articles were selected based on the inclusion and exclusion criteria presented in Table 1. Articles were excluded if they were not explicitly conducted in SSA and did not investigate the association between heatwaves, wildfires, floods, droughts, cyclones, landslides, etc. and mental health. A study involving several countries was included only if at least one country was from SSA; in this case, information was retrieved only for the SSA country. Studies with multiple articles were also included as separate papers if they presented different findings. In addition, interventional studies that provided a mental health assessment before the intervention were included, and only the pre-intervention outcome was assessed. Studies reporting only non-specific positive mental health outcomes (e. g., happiness, resilience) were excluded due to their broad conceptual scope and inconsistent measurement, which limited comparability and synthesis across studies. The present review focused on clinically relevant or clearly operationalized mental health outcomes (e.g., depression, anxiety, psychological distress, post-traumatic stress) to enable comparability across studies and to assess pathways linking extreme weather events more directly to mental health impacts.

2.2. Quality assessment of included studies

Appropriate quality assessment tools (risk of bias) for quantitative and qualitative studies were applied in the final stage of the full-text review. For quantitative cross-sectional and longitudinal studies, we employed the Newcastle-Ottawa quality appraisal tool (Wells et al., 2011) adapted for cross-sectional (Ribeiro et al., 2020; Nayebirad et al., 2023) and longitudinal designs (Wells et al., 2011). The criteria were segmented into three domains: (i) sample selection (maximum five scores for cross-sectional and four for longitudinal), (ii) comparability among subgroups and confounder control (maximum two scores), and (iii) outcome assessment and statistical tests (maximum three scores). Cross-sectional articles were graded as unsatisfactory (<5 points), satisfactory (5–6), good (7–8), or very good (9–10) based on the points awarded in each domain. Longitudinal studies were graded as poor if they were given 0 or 1 star in the selection domain, as fair if they were given two stars, or good if they were given 3 or 4 stars in the selection domain. Any articles of poor/unsatisfactory quality were excluded from further analyses.

For qualitative studies, we used the Critical Appraisal Skills Programme (CASP) Tool (CASP). The tool contains ten questions divided into three sections: (i) Section one evaluates the extent to which the results are valid in the context of the chosen methodology; (ii) Section two analyses the findings clearly; and (iii) Section three appraises the value and relevance of the results. Answers are either “yes,” “no,” or “cannot tell.” The appraisal summary is divided into two categories: positive/methodologically sound (the study provides clear and credible findings and is valuable to practice or theory, offering useful insights) and negative/poor methodology (the study has significant methodological flaws or poorly reported results, limiting its usefulness). No cut-off is provided, but the checklist provides consistent guidance for responding to each section, serving as a guide for reviewers.

Additionally, two further quantitative studies included in this review had unique designs and required design-specific quality assessment tools. The studies were a pre-post design with no control group (Nöthling et al., 2024) and a randomized-controlled trial (Ugwuoke et al., 2023). We employed two design-specific tools from the National Heart, Lung, and Blood Institute (NHLBI) at the NIH (NIH, 2013). Even though these two tools are not divided into domains, they are grounded in the same aspects as the previously described tools: sample selection, comparability across subgroups, confounder control, and outcome assessment and statistical tests. The NIH provides no cut-off points but guides authors into better decision-making. Any studies identified by the reviewers as poor quality during the quality assessment were excluded. The detailed quality assessments from the quantitative and qualitative studies are presented in Appendices S2–S6.

2.3. Data synthesis

Information extracted from the included studies included title, author list, year of publication, country where the research was carried out, period of study, specific population of focus (e.g., farmers, women), study design, sample size, statistical methods employed in the analysis, and exposures and outcomes assessed by the authors. We organized the outcomes broadly following the International Classification of Diseases (ICD) coding – 10th edition as guidance (ICD-10 Version, 2019). Other conditions in general that were appraised by studies and are not necessarily among the ICD-10 codes are grouped under “mental health in general” and “psychological distress”. Additionally, we identified the specific tools used in each article to assess mental health outcomes, including the Generalized Anxiety Disorder Scale (GAD-7) for generalized anxiety disorder, and the Patient Health Questionnaire (PHQ-9) for depressive disorder.

3. Results

Of the 3243 initially identified papers, forty-five were selected for full-text review, and only fifteen were included in the review (Table 2). The detailed screening procedures and reasons for article exclusion are displayed in the PRISMA 2020 flowchart (Fig. 1). No study was excluded due to poor quality. Regarding the quality appraisal, among the included cross-sectional studies, only one study received a satisfactory grade (Abunyewah et al., 2024), whereas the others received good or very good ratings. The cohort (Cerna-Turoff et al., 2024) and the randomized controlled trial (Ugwuoke et al., 2023) studies were graded as good, and the pre-post study (Nöthling et al., 2024) received a fair grade. We were hampered from performing a meta-analysis due to significant heterogeneity and the lack of comparability between the studies’ exposures and outcomes.

Table 2. Summary of included studies.

	Author year	Country	Specific population	Study design	Climate variable	Psychopathology	Objective	Result
1	Abass et al. (2022)	Ghana	≥20 years, 767 flood- prone people	Quantitative (Cross-sectional)	Flood exposure (exposure to flood-related Events Scale)	Psychological distress (Kessler Psychological Distress Scale)	To examine flood exposure’s impact on psychological distress among Ghanaian flood survivors and assess age and sex differences in this association.	Flood exposure was significantly associated with psychological distress in the total sample. Findings showed women experienced more distress than men and those aged 20–59 more affected than those aged ≥ 60.
2	Abass et al. (2023)	Ghana	≥20 years, 767 flood- prone people	Quantitative (Cross-sectional)	Flood exposure (exposure to flood-related Events Scale)	Psychological distress (Kessler Psychological Distress Scale)	To examine how flood stressors indirectly affect psychological distress through flood risk perception in flood-affected Ghanaian communities.	Mental distress correlated strongly with flood stressors. Flood stressors not limited to loss of property or livelihood assets, financial losses, personal injuries were significantly linked with a higher risk of mood disorders.
3	Abunyewah et al. (2024)	Ghana	Peri-urban farmers ≥ 18 years, N = 507	Quantitative (Cross-sectional)	Drought (Drought Impact Measurement Scale (DIMS)	Psychological distress (DASS-21 for stress), depression, and anxiety (DASS-D and DASS-A)	To investigate drought’s effects on farmers’ mental health — specifically, depression, anxiety, and stress — and examine personal social capital’s moderating role in this relationship.	Drought shows significant positive relationships with depression, anxiety, and stress. Personal social capital moderates the relationship between drought impacts and mental health outcomes, serving as an essential resource for drought-related mental health challenges.
4	Adams and Nyantakyi-Frimpong (2020)	Ghana (Accra)	Residents from the Old Fadama, the largest informal settlement in Accra, N = 20	Qualitative (Cross-sectional / Photovoice)	Floods	Qual: Anxiety, psychological distress, and fear	To examine community impacts of flooding and explain differentiated vulnerabilities and health outcomes from climate- induced flooding.	Participants reported acute anxiety and stress from flooding, expressing fear at signs of rain. Managing flooded conditions severely affects their mental health. Residents felt attached to Old Fadama, but flooding threatened their identity and well-being. Their homes became sites of distress due to extreme weather. Participants cited health issues from floodwaters, including infections, malaria, and cholera. The contaminated waters posed serious threats to residents and their children.
5	Bahta et al. (2016)	South Africa	Farmers from the OR Tambo District in South Africa, men and women, N = 87	Quantitative (Cross-sectional - semi-structured questionnaire on perceptions)	Drought	Psychological distress (Researcher-designed survey)	to assess farmers’ perceptions of agricultural drought, focusing on drought vulnerability, gender, social networks, the government’s role, stress, and safety.	Most farmers (79%) perceived psychological stress as affecting farm activities, thereby increasing drought vulnerability. When troubled by family issues, financial or health challenges before drought onset, farmers reported that delayed rain and food shortages worsened their psychological health.
6	Beyeler et al. (2023)	Kenya	Farmers living with HIV, N = 40	Qualitative (IDIs)	Higher temperatures, more drought, extreme rain events, and flooding; changes in the timing of the rainy season; and increasing weather unpredictability	Psychological distress, depression, annoyance, demoralization, discouragement, hopelessness, and weather disorientation	To identify pathways through which climate change impacts mental well-being among Kenyan smallholder farmers with HIV.	The study found that participants reported significant changes in weather patterns, including rising temperatures, droughts, and floods. While not all directly attributed these to climate change, they experienced emotional impacts like stress and depression. Severe emotional distress was caused by the disruption of livelihoods which was found to be similar to personal losses. Many faced damage to homes and farms, leading to anxiety and grief. The events caused long-term trauma, particularly during rainy periods, with some reporting debilitating psychological effects.
7	Cerna-Turoff et al. (2024)	Ethiopia (India, Peru, Vietnam)	young adults aged 19–26 years, N = 1766 of 5585	Quantitative (longitudinal cohort follow-up)	Drought	Depression (Patient Health Questionnaire depression scale-8, (PHQ-8) and anxiety (Generalized Anxiety Disorder scale-7 (GAD-7)	To estimate how three patterns of natural hazard exposure influence anxiety and depression symptoms among young adults in low- and middle-income countries, and to examine how these exposure patterns differ between women and men.	Low levels of anxiety and depressive symptoms were found among young adults living in communities exposed to natural hazards in Ethiopia on average.
8	Cooper et al. (2019)	Ethiopia	20–70 years old, rural; N = 48	Qualitative (FGDs and IDIs)	Drought	Psychological distress	To explore how water security affects emotional well-being, and to examine implications for pastoralist livelihoods and mental health outcomes amid climate change.	Pastoralists’ emotional well-being was deeply impacted by water insecurity during dry seasons. Worry and fear reflected their feelings of disempowerment and helplessness. Tasks like digging scoop holes for poor-quality water left me feeling fatigued and disappointed. Men faced displacement from long journeys to water sources, while women struggled with childcare and water collection. Single-headed households and the elderly were particularly vulnerable to water- related emotional challenges. No gender differences were noted in emotional expression.
9	Heaney and Winter (2016)	Tanzania	rural-to-urban migrants and permanent rural residents, over 18 years old; N = 28 matched control (migrant and non-migrant) 8 males, 6 females	Qualitative (Case-study design)	Drought as a cause for migration and mental health outcomes	Negative emotions	This case study uses matched Maasai migrant and non-migrant samples to examine: (1) how perceptions of health differ between climate-driven urban migrants and rural non-migrants, (2) how perceived health problems differ between groups, and (3) how help-seeking attitudes and behaviors vary between groups.	Participants across both migrant and non-migrant groups viewed mental health as crucial to overall health, equating it with happiness and low stress. Migrants emphasized mental health more strongly, while non-migrants focused on physical health. Migrant participants reported increased stress and loneliness connected to heavy responsibilities, lack of support, and homesickness following EWEs.
10	Mwenda et al. (2023)	Kenya	Patients, N = 60 in-patients and 121 out-patient; FGD N = 24; KIs (N = 35) and household survey N = 288	Mixed methods (rainfall/ temperature data, mental disorders epidemiological data (2006-2014) from the health information system	total annual rainfall (1984-2013)	Dissociative, sleeping, and adjustment disorders, eating disorders, poly-substance disorder, anxiety (in-depth observation and enhanced mental health assessment guidelines)	To determine the impact of climate change disasters on mental health in Isiolo County, Kenya.	Mental disorder comorbidity revealed associations with disaster risks that increase illnesses. The study found high disorder prevalence and low resilience as significant pathways for mental health problems.
11	Myers et al. (2022)	Tanzania (Maasai)	Women ≥ 18 years, N = 71, non-clinical community sample – diagnosed patients were excluded (convenience sample) – 28 qualitative interviews	Mixed methods (Cross-sectional)	Overall EWEs (through the life events checklist (LEC)), focusing on drought.	Qualitative appraisal of psychological distress	To estimate community prevalence of voice-hearing, examine demographic correlates and hypothesized correlates (psychological stress and traumatic events), and explore phenomenological experience of voice-hearing among Maasai women in Tanzania.	Quantitative research cannot be included because the exposure is not specific to extreme weather events, as measured by the Life Events Checklist. The women worried about food security, particularly for children. The women experienced significant levels of distress when environmental conditions threatened the well-being of their children and livestock. There was also reported stress from selling cattle due to water insecurity.
12	Nöthling et al. (2024)	South Africa, KZN	women, 18–45-years, N = 73 interviews, 69 repeat measures	Quantitative	Floods	Psychological distress (Kessler Psychological Distress Scale), Depression (Centre for Epidemiologic Studies Depression Scale, CES-D) and anxiety (GAD-7)	To assess damage, loss, injury, and death from floods in Durban, South Africa (April 2022), and mental health changes pre- to post-floods in a low-income area.	The study found that post-flood depression scores declined significantly, while emotional distress, anxiety, and PTSD showed no significant changes. Flood-related infrastructure loss was linked to higher emotional distress and anxiety. Food and water shortages and prior trauma correlated strongly with pre- and post-flood mental health issues. Structural equation models revealed that pre-flood trauma, food insecurity, and emotional distress predicted post-flood emotional distress, while pre-flood anxiety predicted post-flood anxiety. Pre-flood trauma and food insecurity increased post-flood mental health symptoms through pre-flood distress.
13	Taukeni et al. (2016)	Namibia	Children between 8 and 18, N = 429 included in the analysis	Quantitative (Cross-sectional)	Flood exposure	PTSD (Child Trauma Screening Questionnaire (CTSQ)	To assess PTSD in school children from floods. Hypothesis: Younger children show higher PTSD signs.	Two years post-floods, 55.2% of younger learners and 72.8% of older learners reported trauma symptoms. Older learners showed higher trauma scores. While gender effects were a pathway for PTSD, females aged 13 + tended to experience more trauma than males.
14	Ugwuoke et al. (2023)	Nigeria	Rural, adults < 18 years, N = 120	Quantitative (Group- randomized control design)	Floods	Anxiety (Screen for Adult Anxiety Related Disorders)	Investigated REFHT’s effect on flood-induced anxiety among farmers in Anambra State, Nigeria.	Farmers who received REFHT had much less anxiety after the treatment, while those on the waitlist did not improve. Both men and women benefited, with men showing a slightly bigger decrease, but gender did not make a real difference in the results. The lower anxiety levels lasted over time, showing that REFHT works well in the long term.
15	van Straten and Ncube (2023)	South Africa	N = 41	Mixed qualitative method (Survey on coping items. One open- ended question to determine the perceived impact of the flood disaster.	Floods	Qualitative appraisal of psychological distress	To assess the mental and spiritual health of KZN flood survivors.	The emotional responses to witnessing suffering and loss include sadness, anger, loneliness, fear, grief, and shock. Respondents showed distress over others’ pain and death, especially children’s. Those experiencing mental illness often seek religious comfort, highlighting spirituality’s role in mental health.

Fig. 1. PRISMA 2020 flow diagram showing the article selection process.

The 15 studies were conducted in seven SSA countries (Fig. 2): Ghana (Abunyewah et al., 2024; Abass et al., 2023; Abass et al., 2022; Adams and Nyantakyi-Frimpong, 2021), South Africa (Nöthling et al., 2024; Bahta et al., 2016; van Straten and Ncube, 2023), Kenya (Cooper et al., 2019; Mwenda et al., 2023; Beyeler et al., 2023), Ethiopia (Cerna-Turoff et al., 2024), Tanzania (Heaney and Winter, 2016; Myers et al., 2022), Nigeria (Ugwuoke et al., 2023), and Namibia (Taukeni et al., 2016). The EWEs assessed included floods reported in eight studies (Nöthling et al., 2024; Ugwuoke et al., 2023; Abass et al., 2023; Abass et al., 2022; Adams and Nyantakyi-Frimpong, 2021; van Straten and Ncube, 2023; Beyeler et al., 2023; Taukeni et al., 2016), drought assessed in seven studies (Abunyewah et al., 2024; Cerna-Turoff et al., 2024; Bahta et al., 2016; Cooper et al., 2019; Beyeler et al., 2023; Heaney and Winter, 2016; Myers et al., 2022), and extreme rainfall assessed in one study (Mwenda et al., 2023).

Fig. 2.

Map of the African continent with a focus on the countries in which studies were found. Darker blue shades indicate a higher number of studies in a specific country, whereas lighter shades represent fewer studies. Countries without literature included are colored grey. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Source: authors

The most studied outcome was psychological distress (n = 10), followed by anxiety (n = 6), depression (n = 4), and PTSD (n = 1). Dissociative, adjustment, eating, and sleeping disorders was reported in one study (Mwenda et al., 2023). Further aspects of mental health characterized by negative emotions, such as fear, hopelessness, annoyance, and discouragement, were also assessed in three of the 15 studies (Adams and Nyantakyi-Frimpong, 2021; Beyeler et al., 2023; Heaney and Winter, 2016).

The studies employed diverse methodological approaches, with eight using quantitative methods (Nöthling et al., 2024; Ugwuoke et al., 2023; Abunyewah et al., 2024; Cerna-Turoff et al., 2024; Abass et al., 2023; Abass et al., 2022; Bahta et al., 2016; Taukeni et al., 2016), four utilising qualitative approaches (Adams and Nyantakyi-Frimpong, 2021; Cooper et al., 2019; Beyeler et al., 2023; Heaney and Winter, 2016), and three implementing mixed-method designs (van Straten and Ncube, 2023; Mwenda et al., 2023; Myers et al., 2022).

A range of mental health and psychological assessment tools were employed across the included studies. The Kessler Psychological Distress Scale (K10) was used in three studies (Nöthling et al., 2024; Abass et al., 2023; Abass et al., 2022) along with other established measures, such as the Depression Anxiety Stress Scale (DASS-21) (Abunyewah et al., 2024), Generalized Anxiety Disorder Scale (GAD-7) (Nöthling et al., 2024; Cerna-Turoff et al., 2024), Center for Epidemiologic Studies Depression Scale (CES-D) (Nöthling et al., 2024); Screen for Adult Anxiety Related Disorders (Ugwuoke et al., 2023), and Child Trauma Screening Questionnaire (Taukeni et al., 2016). Bahta et al. (Bahta et al., 2016) used a researcher-designed survey to assess psychological stress, whereas two studies (van Straten and Ncube, 2023; Myers et al., 2022) qualitatively appraised psychological distress. Mwenda et al. (Mwenda et al., 2023) did not use a standard scale but instead employed in-depth observation and enhanced mental health assessment guidelines to rank present or past symptomatology using DSM-5 or ICD-11 criteria among pastoralists in Isiolo, Kenya.

3.1. Association of extreme weather events with mental health outcomes

Drought has consistently been linked to a range of adverse mental health outcomes. In Ghana, peri-urban farmers exposed to drought reported higher rates of depression, anxiety, and stress. These findings suggest a pervasive psychological toll stemming from reduced agricultural productivity and resource scarcity resulting from the loss of produce (Abunyewah et al., 2024). In Ethiopia, longitudinal data revealed that young adults with histories of drought exposure exhibited higher mean anxiety and depression scores (Cerna-Turoff et al., 2024). Qualitative evidence from Kenya showed that smallholder farmers living with HIV experienced stress, hopelessness, and depression due to the disruption of their livelihoods caused by prolonged droughts (Beyeler et al., 2023). These disruptions were compounded by the financial strain of losing crops and livestock, which many described as central to their sense of identity and purpose (Beyeler et al., 2023). Similarly, pastoralists in Ethiopia reported significant emotional distress associated with water insecurity during droughts. Participants reported chronic worry, fear, and fatigue due to physically demanding tasks. One of them is water collection, which was further exacerbated by feelings of helplessness, as drought conditions limited their ability to support their families and secure their livelihoods (Cooper et al., 2019). Drought-related food insecurity was associated with increased psychological distress. In South Africa, communal farmers have reported that prolonged droughts heightened their vulnerability to stress. This situation was especially challenging when combined with other existing issues, such as financial instability, family conflicts, and pre-existing health problems. These findings illustrate the cumulative psychological burden that drought imposes on already-strained populations (Bahta et al., 2016).

Flooding has been strongly associated with psychological distress, PTSD, and other mental health conditions. In Ghana, a cross-sectional study found a statistically significant association between flooding exposure and psychological distress, with females reporting higher distress levels than males. The psychological impact was more pronounced among adults aged 20–59 years, while those aged 60 and above were less affected (Abass et al., 2022). Flooding has had a profound impact on children. In Namibia, two years after a severe flooding event, 55.2% of children aged 8–12 years and 72.8% of adolescents aged 13–18 years reported trauma symptoms indicative of PTSD. Older adolescents exhibited significantly higher trauma scores (Taukeni et al., 2016). In South Africa, a study conducted in Durban examined the mental health impact of flooding in a low-income community. Emotional distress, anxiety, and PTSD persisted among flood survivors, particularly among those who experienced infrastructure losses. Pre-existing conditions such as food insecurity further exacerbate post-flood psychological outcomes (Nöthling et al., 2024). Qualitative evidence highlights the lived experiences of the flood-affected populations in Ghana’s informal settlements. Residents reported chronic stress, fear, and anxiety during the rainy season as recurrent flooding disrupted their daily lives. Many expressed feelings of despair over the loss of possessions and health risks posed by contaminated floodwaters, with some describing their homes as sites of emotional distress rather than safety (Adams and Nyantakyi-Frimpong, 2021).

Although studied less than other EWEs, heavy rainfall is still associated with notable mental health challenges. In Kenya, communities experiencing erratic and extreme rainfall patterns reported increases in adjustment disorders, dissociative symptoms, and anxiety (Mwenda et al., 2023). The disruption to agricultural productivity caused by excessive rainfall significantly contributes to psychological distress, as families struggle to recover from financial losses (Mwenda et al., 2023). Additionally, prolonged periods of heavy rainfall were identified as compounding stress by exacerbating pre-existing vulnerabilities, such as food insecurity. In rural areas, the psychological toll of rainfall-related disruptions is evident in the increased prevalence of anxiety and emotional exhaustion. These effects were particularly pronounced in communities dependent on farming and livestock, where the inability to adapt to unpredictable weather patterns heightened feelings of helplessness and despair (Mwenda et al., 2023).

3.2. Moderators and mediators of the association between EWEs and mental health outcomes

Several factors were found to moderate and mediate the relationship between EWEs and mental health outcomes, underscoring the complexity of these associations. Social support systems, particularly personal social capital, emerged as significant moderators. For instance, in Ghana, peri-urban farmers with higher levels of social capital experienced less severe mental health impacts from drought (Abunyewah et al., 2024). This protective effect highlights the importance of strong community networks and interpersonal connections in buffering psychological distress during an environmental crisis. Similarly, participants in qualitative studies from Ethiopia and Kenya emphasized the role of community support in mitigating emotional distress caused by water insecurity and agricultural disruptions (Cooper et al., 2019; Beyeler et al., 2023).

Gender has consistently been a factor in determining susceptibility to the mental health effects of extreme weather events, with most research highlighting that women are more adversely impacted. For instance, in flood-prone Ghanaian communities, women reported higher psychological distress levels than men, reflecting the intersection between flooding and their greater caregiving responsibilities and socioeconomic vulnerabilities (Abass et al., 2022; Adams and Nyantakyi-Frimpong, 2021). Additionally, in Maasai communities in Tanzania living in dry areas, women reported stress and emotional exhaustion linked to water and food insecurity, often exacerbated by societal expectations to manage household needs during droughts (Heaney and Winter, 2016; Myers et al., 2022).

Older children were found to be especially susceptible to the effects of EWEs on their mental health, highlighting how age plays a role in vulnerability. In Namibia, older adolescents (aged 13–18 years) were more likely to report trauma symptoms after flooding than younger children (aged 8–12 years), likely because of increased cognitive awareness and greater exposure to disaster-related stressors (Taukeni et al., 2016).

Pre-existing trauma and mental health conditions amplify the psychological impact of EWEs. In South Africa, individuals with prior trauma or food insecurity were more likely to report heightened anxiety and emotional distress after floods (Nöthling et al., 2024). Similarly, in Kenya, low baseline resilience levels were associated with higher prevalence rates of mental disorders following extreme rainfall and flooding events (Mwenda et al., 2023).

Economic factors function as both mediators and amplifiers of the mental health impact of EWEs. Drought-induced crop failures and loss of income contributed to increased anxiety and depression among farmers in Ghana and Kenya (Abunyewah et al., 2024; Beyeler et al., 2023). The cascading effects of economic insecurity, including the inability to meet basic needs, further intensified psychological distress.

In South Africa, flood survivors frequently turned to religion and spirituality as coping mechanisms to manage emotional distress (van Straten and Ncube, 2023). This highlights the dual role of spiritual beliefs in providing comfort and a sense of meaning during environmental crises.

3.3. Systems thinking analysis of extreme weather events (EWEs) and mental health outcomes

The connection between extreme weather events and mental health was influenced by various interrelated factors, such as financial hardship, social isolation, and environmental disturbances. Based on this synthesis, we identified significant pathways that increase vulnerability to poor mental health outcomes in the aftermath of an EWE. Our synthesis highlighted that psychological distress often results from the immediate impact of EWEs. Food and water shortages were key contributors to distress, especially in communities with pre-existing food insecurity (Nöthling et al., 2024; Cooper et al., 2019). Resource scarcity resulting from reduced agricultural productivity, income loss, and uncertainty about future livelihoods also significantly increased psychological distress (Abunyewah et al., 2024; Mwenda et al., 2023). Additionally, flooding was associated with acute stress and ongoing worry, as individuals struggled to manage flooded living conditions and the health risks posed by contaminated water (Adams and Nyantakyi-Frimpong, 2021).

Flooding and prolonged drought were strongly associated with depression, linked to their cumulative impact on livelihoods (Abunyewah et al., 2024). Depressive symptoms were also associated with the loss of homes and community networks due to EWEs such as flooding, as well as the loss of cultural and environmental attachment, which was identified as disrupting the traditional way of life and eroding community connection to their land (Adams and Nyantakyi-Frimpong,2021; Cooper et al., 2019). Anxiety was frequently linked to the anticipation of future events. The unpredictability of rainfall patterns, fear of flooding, and the subsequent associated impact on livelihoods were linked to increased anxiety levels in Kenya and Ghana (Adams and Nyantakyi-Frimpong, 2021; Mwenda et al., 2023). Additionally, the uncertainty associated with drought and erratic weather patterns increased anxiety levels for young adults and women, reflecting sustained worry about the availability of resources (food and water) and future security (Cerna-Turoff et al., 2024; Myers et al., 2022).

EWEs were strongly associated with PTSD via several interconnected pathways. Direct exposure to traumatic events, such as life-threatening floods or drought-induced resource scarcity, often resulted in PTSD symptoms, particularly in vulnerable populations, such as children and adolescents (Taukeni et al., 2016). Displacement and loss of homes and livelihoods further exacerbate PTSD, as seen in flood survivors in Ghana and Ethiopia, who experienced flashbacks and emotional numbness tied to disrupted stability and cultural disconnection (Adams and Nyantakyi-Frimpong, 2021; Cooper et al., 2019). Witnessing death (especially of a close relative or family member) or severe suffering during EWEs, such as flood-related fatalities in South Africa, intensified psychological trauma and feelings of helplessness (van Straten and Ncube, 2023). Recurrent EWEs compound PTSD risk by fostering a chronic sense of danger, whereas pre-existing vulnerabilities, such as prior trauma or food insecurity, amplify susceptibility to post-event psychological distress, as evidenced by studies in South Africa (Nöthling et al., 2024; Bahta et al., 2016). Prolonged recovery timelines also sustained PTSD symptoms, especially among populations with limited access to psychological support, highlighting the urgent need for targeted mental health interventions in EWE-affected regions (Taukeni et al., 2016).

The systems analysis (Fig. 3) demonstrates the complex interplay between exposure to EWEs and mental health problems, highlighting the various direct and indirect impacts identified in this review. This analysis underscores the multifaceted nature of mental health impacts of EWEs and the importance of considering environmental, social, and individual-level factors to understand and address these challenges.

Fig. 3.

Systems diagram of the interplay between extreme weather events (EWEs) and mental health outcomes. PTSD: Post Traumatic Stress Disorder.

Source: authors

4. Discussion

This systematic review encompasses evidence from seven SSA countries and demonstrates that EWEs significantly impact the mental health of the studied populations, supporting findings from prior research on this subject (Ebi et al., 2021; Cianconi et al., 2020; Chique et al., 2021; Deglon et al., 2023). Besides, we build on the work of Deglon et al. (Deglon et al., 2023) by mapping pathways between exposure to EWEs and mental health outcomes, and by identifying vulnerable population groups within the SSA context most affected by EWEs.

The results reveal direct and indirect impacts of EWEs like floods, intense rainfall, and droughts on anxiety, depression, PTSD, and psychological distress – similar results from a review in South and Southeast Asia (Patwary et al., 2024). The direct impacts identified in this review include livestock losses and resource depletion, food and water shortages, damage to infrastructure, and loss of agricultural land (Nöthling et al., 2024; Ugwuoke et al., 2023; Taukeni et al., 2016). Longer-term direct impacts are operated through the loss of multiple social and communal pathways (Ebi et al., 2021), including displacement of populations and disruption of social networks (Adams and Nyantakyi-Frimpong, 2021; Cooper et al., 2019), as well as economic instability, food and water insecurity (Cerna-Turoff et al., 2024; Mwenda et al., 2023; Myers et al., 2022). Indirect impacts on mental health were seen to operate from prolonged recovery periods, using up individual resilience resources (Taukeni et al., 2016). This relationship between EWEs and mental health appears to be moderated by several factors, including economic impact, food and water insecurity, social disruption and loss of identity, and physical environmental changes (Nöthling et al., 2024; Ugwuoke et al., 2023; Heaney and Winter, 2016; Taukeni et al., 2016; Kadio et al., 2024; Abunyewah et al., 2024; Cerna-Turoff et al., 2024; Abass et al., 2023; Abass et al., 2022; Adams and Nyantakyi-Frimpong, 2021; van Straten and Ncube, 2023; Cooper et al., 2019; Mwenda et al., 2023). While we cannot necessarily link the EWEs observed in our review to climate change, the multifaceted interactions between the direct and indirect impacts of EWEs on mental health underscore the need for comprehensive, holistic approaches to understand and address their mental health impacts (Judd et al., 2002; Coêlho et al., 2004).

A key finding was the cascading and compounding nature of the impact of EWEs on mental health, where EWEs trigger chains of impacts that interact with existing vulnerabilities and create a compounding effect (Ebi et al., 2021). These findings mirror the situation in the Global North (Cianconi et al., 2020; Chique et al., 2021) and in other developing countries (Rataj et al., 2016; Patwary et al., 2024). Additionally, EWEs are now considered determinants of mental health and well-being as they directly and indirectly contribute to a multitude of social problems (Panda et al., 2024; Betro, 2024). For example, drought can lead to crop failure, affecting household income and food security, and each step brings its own mental health challenges while amplifying others. These effects of heat exposure on mental health after extended periods of drought have been well documented. Furthermore, economic losses due to property damage, loss of income, and reduced employment opportunities, combined with decreased economic productivity in farming communities, have been linked to an increase in suicide cases among farmers (Vins et al., 2015). Prolonged droughts have also led to population displacement (Shultz et al., 2018), caused a loss of attachment among impacted populations to the natural environment they are used to (Cunsolo et al., 2020; Fritze et al., 2008), and promoted social conflict and inter-group violence (Hsiang et al., 2011; Gleick, 2014). In Australia, prolonged droughts have majorly impacted rural populations, leading to psychosocial distress, generalized anxiety, depression, and an increased incidence of suicide (Bourque and Cunsolo, 2014; Berry et al., 2010). This cascading effect appears particularly pronounced in SSA contexts, where baseline resilience may already be compromised by poverty and limited healthcare access (Tessema et al., 2022).

Our review identified age, sex, and socioeconomic disparities in vulnerability to mental health conditions linked to adverse weather. Research has already established that women and older adolescents are more vulnerable after experiencing extreme weather events, highlighting the unequal mental health effects of climate change on specific vulnerable populations (Deglon et al., 2023). This gender disparity likely reflects both biological vulnerabilities (structural and functional brain anomalies in men and women, as well as biochemical responses to stimuli) (Nantel-Vivier and Pihl, 2008) and sociocultural factors unique to SSA contexts (Deglon et al., 2023). The stronger effects of EWEs on mental health observed in women may be attributed to various intersecting factors, including increased caregiving responsibilities during disasters, economic vulnerabilities, and reduced access to resources to mitigate the impact of EWEs (Cianconi et al., 2020; Berry et al., 2018; Chique et al., 2021; Rataj et al., 2016). Age-related vulnerabilities (as seen in the case of adolescents) reflect developmental differences in trauma processing and coping mechanisms (Masten, 2021; Downey and Crummy, 2022). Additionally, populations dependent on natural resources for livelihoods, such as farmers and pastoralists, demonstrated vulnerability through both the direct impacts of extreme events and indirect effects on economic security, with those over 60 years old faring better (Nantel-Vivier and Pihl, 2008; Conger et al., 1992).

The role of socio-ecological factors in shaping mental health outcomes has also been highlighted in previous reviews (Benevolenza and DeRigne, 2019). Our findings support the evidence that social support systems and community-level resources play important roles in moderating the negative impacts of natural and climate-related disasters, reinforcing arguments for considering climatemental health relationships through a systems lens (Deglon et al., 2023). This aligns with emerging frameworks that emphasize how the health impacts of EWEs are mediated by complex interactions among environmental, social, and health-system factors (Ebi et al., 2021; Iwuji et al., 2024; Orievulu et al., 2022).

Following the recommendations of Deglon et al. (Deglon et al., 2023), we aimed to include grey literature in the current review; however, no grey literature was found in the listed sources that met the inclusion criteria (Table 1). Also, there is a paucity of peer-reviewed mental health research from African nations examining climate-related impacts of mental health (Deglon et al., 2023; Rother et al., 2022), with only 15 studies included in our final review, of which three overlapped with the review by Deglon et al. This systematic review revealed important insights into the impact of EWEs on mental health in SSA and identified gaps in the available evidence base. First, there is little research examining the mental health impacts of other EWEs beyond flooding, particularly heat waves and droughts. However, these EWEs are projected to increase significantly in SSA owing to climate change (IPCC, 2022). Second, longitudinal studies that track long-term mental health trajectories are absent (only one was included in this review (Cerna-Turoff et al., 2024), yet they allow for changes in health outcomes to be tracked over time, while capturing the dynamic nature of climate exposures and identifying causal links, which is crucial for developing effective mitigation and adaptation strategies (Desjardins et al., 2023; Zhao et al., 2022). Third, most studies lacked objective measures of the impact of EWEs on mental health (Nöthling et al., 2024; Ugwuoke et al., 2023; Adams and Nyantakyi-Frimpong, 2021; van Straten and Ncube, 2023; Mwenda et al., 2023; Myers et al., 2022; Taukeni et al., 2016) or control groups to provide a counterfactual, making it difficult to establish clear causal relationships between EWEs and mental health among impacted communities (Deglon et al., 2023).

Additionally, research on context-appropriate mental health measures remains limited, including the literature reviewed. Many studies have relied on Western psychiatric concepts that may not adequately capture local expressions of psychological distress and mental health problems/illnesses. This situation highlights the need for research that incorporates Indigenous knowledge systems and culturally relevant mental health conceptualizations.

These limitations have important implications for policy and practice. The paucity of context-specific evidence hampers the development of appropriate mental health policies, programmes, and interventions. Additionally, focusing on individual events rather than cumulative or interactive effects may underestimate the true burden of EWEs on mental health (Ebi et al., 2021). There is an urgent need to build the research capacity of researchers in SSA to analyze the nexus between climate change and mental health, thereby strengthening the evidence base for effective interventions in health and the environment.

Future research should prioritize five aspects: (1) conducting longitudinal studies examining long-term mental health trajectories from exposure to EWEs; (2) evaluating and scaling up interventions that build community resilience and adaptation to climate change impacts while addressing immediate mental health needs; (3) incorporating cultural and context-appropriate measures and conceptualization of mental health; (4) examining how multiple climate change stressors interact with existing vulnerabilities to affect mental health; and (5) understanding protective factors and drivers of resilience in communities affected by climate change (Deglon et al., 2023). Such evidence will be crucial for developing effective responses to what is increasingly becoming a significant public health challenge as EWEs intensify with climate change (Ebi et al., 2021).

Moreover, the present findings will support the development of culturally sensitive, community-based interventions that strengthen local coping mechanisms and social support networks. Interventions for public health could be considered, where feasible, aiming to increase not only resilience against EWEs but also to leverage mental health moderators such as social-, community-, and religion-based support (Xue et al., 2024). Notably, in Haiti, a similarly climate-vulnerable country, a brief community-based intervention combined mental health support with disaster preparedness. Delivered by trained local lay workers over three days to hurricane-affected individuals, the program improved coping skills and household preparedness towards EWEs. Compared to nonprogram participants, participants showed significantly fewer symptoms of depression, anxiety, and PTSD, greater intention to provide mental health–related help, and still exhibited a trend in an increase in social cohesion (James et al., 2020). Another review argues that “faith-based leaders and organizations” are especially important in both urban and non-urban areas to provide post-disaster mental health support, while meeting the spiritual needs of the affected communities (Mishra et al., 2025).

Considering the dearth of evidence on the impact of climate change on the mental health of young people (<18 years) on the continent, future research should consider expanding to this population, as they constitute 40% of the population in Africa (Africa: population by age group, 2021). Further, young people are vulnerable to both climate change and mental health problems (Jorns-Presentati et al., 2021). This research evidence will inform policymaking and climate change adaptation and mental health coping strategies, and promote resilience towards climate-linked mental health outcomes in young people (Hossain, 2025). By identifying vulnerable populations and high-risk areas, findings can guide targeted resource allocation, ensuring that mental health services and interventions are equitably distributed and made accessible. The evidence will also inform training programs for healthcare workers, enhance surveillance systems, and shape EWEs early warning mechanisms (White et al., 2023). Ultimately, integrating mental health considerations into climate policy fosters more holistic, adaptive responses to environmental challenges and public health threats (Hossain, 2025; Schlatter et al., 2025).

5. Conclusions

With the projected increase in frequency and intensity of EWEs in SSA, research on their impacts on populations, particularly vulnerable groups, is increasingly urgent. This review synthesises the available evidence on the association between EWEs and mental health outcomes in SSA. It applies a systems thinking approach to examine both direct and indirect pathways of impact. By explicitly focusing on the intersection of climate-related disasters and mental health in SSA, this review addresses a critical gap in the literature, highlighting an area where both environmental vulnerability and mental health have been insufficiently represented in global health discourse.

The findings of this review have important implications for health and environmental policy in Africa. There is a clear need for integrated, holistic approaches to mental health that are embedded within climate change adaptation strategies, with particular attention to vulnerable populations, including young people. Strengthening health system resilience to address both the acute and long-term mental health impacts of climate change and EWEs is essential. However, this requires a robust regional evidence base, which is currently limited (Ebi et al., 2021; Masten, 2021). Addressing these knowledge gaps while simultaneously building health-system capacity is critical to safeguarding population mental health in the context of a changing climate.

Data availability

This is a systematic review, hence all data utilised are in the body of the manuscript

7. Data sharing

This manuscript is based on a narrative synthesis of the published evidence. Therefore, no data were available to share.