An epidemiological study of mental health problems related to climate change: A procedural framework for mental health system workers

1.1The problem of climate change

The world has faced unprecedented climatic changes over the past 50 years, resulting in significant human and economic losses. The Intergovernmental Panel on Climate Change (IPCC) indicated that global warming is approximately (0.08) degrees and is expected to increase in the coming years. This global warming is amplified by physical systems such as high sea-levels, glaciers, significant drops in the extent of sea ice thickness in the Arctic, and changes in precipitation patterns. Global warming also affects biological systems; as a result, growing international concern about the current growth rate of greenhouse gas emissions and observed climate effects suggests that climate change occurs more strongly than the Intergovernmental Panel on Climate Change [36]. Therefore, studies on the impact of climate change on mental health were rapidly developing and considered a recent field [35, 69].

By surveying the studies conducted on the impact of climate on human mental health, we found many studies on the effects of climate change on human mental health [4, 24, 35, 40, 58]. Hwong et al. [35] noted that most studies about the effects of climate change on mental health were conducted in high-income countries, especially the United States of America (USA) and Australia. The results of these studies cannot be generalized to low-income countries. At the same time, no studies were conducted on low-lying countries to clarify the prevalence of psychological problems associated with climate change.

1.2Climate change in the Arab world

The Regional Assessment Report on Disaster Risk Reduction in the Arab Region of 2021 [48] declared Arab countries at risk. In 2018, Hurricane Sagar landed in Somalia, causing significant economic losses, damaging crops and livestock, and killing thousands of people. 2019 saw a stronger storm recorded in the last 12 years with Hurricane Cyar. The waves have disrupted the Emirates’ road network, underscoring the need to address emergency damage and malfunctions in infrastructure systems. Bahrain and Comoros are small islands and developing countries and face significant challenges related to disaster risk management and reduction as climate change, exceptionally high sea-levels, and drought threatens their residents. For the past five years, the region has suffered from a drought that affected climate variability on its unit frequency, leading to significant losses among rural poor in Jordan, Syria, Iraq, and Morocco. In addition to forest fires posing a threat, Lebanon has recorded more than 1,200 forests since 1981.

Consequently, there have been instances of the massive destruction caused by earthquakes in Syria, Palestine, and Lebanon over the past millennia. In the last 60 years, medium and large earthquakes have also caused several urban areas in Algeria, Egypt, and Morocco (Agadir earthquake in Morocco in 1960, an earthquake in Egypt in 1992). The Arab region is also at risk from biological hazards such as earthquakes, landslides, and tsunamis, as more than 30% of the Arab population lives in medium and high-risk areas. Arab countries have also faced various biological threats, including cholera, yellow fever, and the COVID-19 pandemic. Additionally, changes in rainfall and increased vegetation have led to locust outbreaks in Tunisia, Libya, Morocco, and Saudi Arabia; this problem remains a list, affecting more than 20 countries, indicating food shortages and insecurity for more than 20 million people.

For example, Algeria is one of the 24 hot spots and most vulnerable to climate change due to its location in the Mediterranean. It has been affected by many extreme weather phenomena such as floods, high temperatures, drought, desertification, forest fires, and others. It has caused human losses, many casualties, and significant damage to infrastructure in recent years. The State of Morocco is suffering from severe climatic changes such as drought, changes in the amount of rain, floods, and others, which had severe repercussions, and led to the deterioration of the ecosystem, the increase of epidemic diseases, environmental and food insecurity and the forced migration of populations from some affected areas [7].

Iraq is also ranked fifth among the countries most affected by climate changes, high temperatures, severe drought, declining rainfall, desertification and salinization, and the increase in the spread of dust storms and others, which have led to severe environmental, security, political, and economic repercussions on Iraq that will continue for years to come. Likewise, Yemen is one of the countries most affected by frequent climatic changes, including floods, droughts, and unconventional temperature changes, which have caused severe threats to water, food security, and livelihoods. Lebanon has faced significant climatic changes in temperature, rainfall, drought, and forest fires, affecting the agricultural sector, the economy, and water wealth. In recent decades, Egypt has also faced climatic changes that have had severe repercussions for many sectors, most notably the agriculture and tourism sectors, which have led to enormous impacts on the Egyptian economy and damaged infrastructure, such as sudden changes in temperature, the quantity, and quality of rain, drought, desertification, earthquakes, sea-level rise and the possibility of the disappearance of some coastal cities and other climatic changes [7].

1.3Physical and mental health issues related to climate change

Studies about the effects of climate change on physical health [27, 61, 65] showed a direct health impact of climate, including death and infection. Extreme weather phenomena such as increased maximum temperatures, the spread of infectious diseases, air quality and respiratory diseases, and changes in food and water quality, climate change impacts are increasingly affecting low-income and marginalized people in societies or living conditions from the war in tents and other cruel conditions [11, 27].

Therefore, a wide range of studies continues to enhance knowledge on the impact of climate change on physical health, including, for example, increasing infectious diseases, water, and food increasing chronic and severe respiratory cases, including asthma and sensitivity, and the deaths associated with marine and extreme weather [41]. In 2017, Lancet published the first report on climate change and health and included a recommendation for further research on the effects of climate change on health, particularly mental health.

Human mental health has environmental, social, economic, and political determinants. Literature indicates the impact of climate change on human health, so climate change causes psychological stress and anxiety for human beings today [5, 18, 36,70].

In 2016, Lancet’s report about sustainable development and global mental health emphasized that mental health is “more health conditions for man to neglect” and launched the term “failure of humanity”. The World Health Organization (WHO) [66] defined mental health as physical, mental, psychological, and social, not just the absence of disease or disability. For this, Hayes et al. [32] referred that mental health does not indicate disease, problems, and mental disorders but mental health, resilience, and psychological well-being (PWB). Watts et al. [61] mentioned a continuous expansion and rapid health and climate change research.

1.4Direct and indirect effects of climate change on mental health

Berry, Bowen and Kjellstrom [10] developed a conceptual framework for climate change and mental health. The risk of climate change is divided into three categories: acute (floods, hurricanes, etc.), semi-sharp hazards (bottled drought), and chronic risks (sea-level rise and temperatures). Eventually, the risks associated with climate change led to various direct and indirect psychological and social consequences that are now sponsoring and affecting the most marginalized community. Executive climate change’s direct psychosocial and social consequences include floods, hurricanes, forest fires, and severe free waves. The consequences of indirect climate change on mental health are also spoken through social and economic factors and environmental disorders (famine, civil conflict, displacement, and migration) associated with climate change.

Extreme climatic phenomena lead to psychological and mental results associated with loss and displacement [13]. The results of previous studies [4, 8, 20, 24, 61] revealed that public fears, post-traumatic disorder, and psychological stress have emerged after severe, cruel weather situations. Willox et al. [63] showed that post-traumatic disorder is the most common response to individuals after a disaster. The symptoms of this disorder are recovered once the conditions are restored from security, safety, and community support. Whereas, Willox et al. [63] pointed out some individuals will continue suffering from post-traumatic disorder and several other mental health problems such as sorrow or complex sadness, depression, anxiety disorders, and drug and alcohol abuse.

As a result, climate change leads to various psychological and social consequences. In the same context, Hayes et al. [32] mentioned that climate change’s overall psychological and social impacts are linked to long-term psychological stress resulting from climate change on current and future mental health. Climate change has three main effects on mental health: first, climate change directly increases mental health problems’ spread and severity and significantly impacts mental health systems. Second, weak societies began with disorders of social, economic, and environmental determinants that promote mental health. Finally, there is an emerging understanding of the methods through which global climate change may cause fears and anxiety about the future.

In the same way, Doherty and Clayton [23] said that the psychological effects of global climate change, there are three types of effects: direct effects (for example, acute or painful effects of extreme weather events and changing environment), indirect effects (e.g., threats on mental health based on the observation of the impact, anxiety, uncertainty about future risks), social monuments (e.g., social and chronic social effects of heat, drought or desertification, migration, climate disputes, and after disaster adjustment).

Concerning the direct effects of climate change on mental health, many studies were conducted, including studies on the impact of high temperatures on mental health; previous studies [12, 59] found that extreme humidity increases the hospital’s entry due to mood and behavioral disorders including schizophrenia, mania, and neurological disorders. Other studies [21, 22, 46, 61] found that heat-related mental illness often occurs in persons with poor thermal regulation, any pre-existing problems and psychosocial diseases, and those with drug abuseproblems.

As for the impact of drought on mental health, previous studies [56, 67] showed that drought increases tension and social isolation, protects social relations, and suicide rates in individuals living in rural areas are affected by drought or desertification in Australia. Links [37] also pointed out that climate change will likely tear and communicate community networks by increasing the displacement of coercive societies and migration and economics.

Albrecht [3], McMichael [40], and Ramsay and Manderson [49] refereed those overall threats to the changing climate led to despair. The National Academies of Sciences [42] and Stone and Allen [52] expected that cruel climatic events such as high surface levels, domestic economies, scarcity of resources, and the associated conflict due to climate change cause millions of people around the world during the next century. Also, as mentioned in previous studies [1, 16, 44, 61, 63–65], the growing climatic changes, such as high surface and accidental drought, can change the landscape and water, agricultural conditions, land use, housing, weaken the infrastructure, lead to financial and relationships pressures, and increase the risk of violence and aggression.

Migration causes a loss of sense of opportunity and loss of place, which leads to devastating psychological effects on the mental health of the displaced. In addition, displacement and migration due to extremist climatic conditions directly impact human mental health. In this context, previous studies [47, 52] showed that displacement and migration raised psychological whether the cause of migration is an escape from violence and wars, destroying livelihoods, extreme poverty, and natural disasters.

Forestry, floods, and hurricanes are the other environmental disasters resulting from climate change, and many studies were conducted on their effects on mental health [9] found that the most vulnerable societies to forest fires increase the prevalence of post-traumatic stress disorder, psychological distress, and depression associated with fires. The study conducted by Tunstall et al. [54] also revealed high mental health problems among flood-affected populations. Previous studies [22, 29] confirmed the spread of anxiety and mood disorders among survivors of Hurricane Katrina. Dodgen et al. [22] found high levels of anxiety and suicide after Hurricane Andrew in 1992. Also, previous studies [16, 19] showed an increase in depression, domestic violence, suicide attempts, and post-traumatic trouble in the USA after being subjected to Katrina. Coyle and van Susteren [19] also explained high abuse rates for children in the wake of Cyclone Florida, USA.

In addition to these direct effects of climate change on mental health, the indirect results of climate change can also occur on mental health through damage to physical and social infrastructure and its influences on physical health, food, and water. In a systematic review, Vins et al. [55] noted that the economic impact of land degradation is the most prominent causal path connecting drought and mental health. It is also suggested [11, 25] that insecurity in the income associated with drought increases the risk of suicide among farmers. OBrien et al. [45] and Vins et al. [55] found drought or desertification indirectly affects mental health. Long-term food and water supply can later affect land workers’ economic and psychological well-being, often affecting those living in rural and remote communities. Also, the study by [31] found that long-term drought leads to conflict and forced migration, resulting in post-traumatic disorder, anxiety, andtrauma.

1.5The need for climate psychology

As psychology is concerned with studying human behavior in both crises and natural conditions, climate psychology is one of the modern branches of psychology that originated during the world’s many catastrophic climate changes. Hogget and Robertson [33] referred to climate psychology, aims to understand further the psychological processes that occur in response to climate change, loss of biological diversity and their consequences, and search for creative communication with individuals on climate change; contribute to the creation of personal, societal, cultural, political changes; support policymakers to make effective change; enhance the ability to adapt to the devastating effects of climate change now and future and take cognitive and behavioral procedures based on scientific evidence to address the escalating threat to climate change.

Because of the increasing exposure of society to climate change risk, there was greater interest in understanding the psychological processes behind the resistance to appropriate action, particularly the climate change phenomenon. The assets of climate psychology returned the psychologist “Harold Sears” from the amazing factors that affect people and isolate them from things in nature. Ecological psychology also severely affected climate psychology and emphasized the principle of people’s relationships in the natural world. More recently, the literary base for the same climate scientists began to focus on the intense emotions associated with climate change [7, 33, 43].

Thus, everyone understood that climate change’s global effects threaten human health. The WHO [67, 68] report refers to an increase of 250,000 excess deaths annually between 2030 and 2050 due to the effects of climate change. It is well known for climate change. Deaths associated with heat rise increased infectious diseases such as dengue and malaria fever, increased respiratory diseases, and deaths from extreme weather phenomena. The least known effects of climate change are mental health. Through the above, we can say that last century, studies did not directly discuss the impact of climate change on human mental health. Recently, studies have emerged to detect climate change on mental health.

As long as the reality of the Arab world and what is happening in natural disasters - as part of the World Climate System - human and economic losses incurred by some Arab countries due to extremist climatic changes, as well as the absence of disaster risk management plans and weak mental health systems, as well as the lack of epidemiological studies on the effects of climate change on the mental health. Based on the current literature, we can test the hypothesis that climate change results in psychological problems. Therefore, this study seeks to determine the prevalence of mental health symptoms related to climate change in the Arab world and to detect the differences in mental health symptoms associated with climate change due to gender, educational class, marital status, and residing country [7].

2.1Design and participants

This quantitative study featured a cross-sectional survey descriptive to determine the prevalence of mental health problems related to climate change in Arab countries and a comparative design to detect the differences in the mental health problems related to climate change due to demographic variables. The online Raosoft sample size calculation methodology [50] was used to calculate the sample size. According to this method a minimum of 643 participants is needed; given that the margin of error alpha (α) = 0.01, the confidence level is = 99%, total population = 430,753,333, and the response of distribution = 50%. The number of responses to the online questionnaire was 1080 replies.

2.2Data collection instrument

The Mental Health Problems related to Climate Change Questionnaire (MHPCCQ) was developed online using Google Forms. The online link was sent to many individuals in several Arab countries. This questionnaire consists of 40 items divided into eight sub-questionnaires: climate fears, climate anxiety, climate depression, climate obsessive-compulsive, climate grief, climate anger, climate alienation, and climate somatic symptoms. Answers are given using a 5-point Likert questionnaire (never = 1 to very much = 5).

2.3Data analysis

Data were statistically analyzed using SPSS Statistics, version 21 (IBM Corp., Armonk, NY, USA). Descriptive statistics such as percentage, frequencies, mean and standard deviation were calculated for sociodemographic variables. The Kolmogorov-Smirnov test examined the normality of the MHPCCQ subscales. Pearson’s correlation coefficient was used to calculate the correlations between scale items and subscales. Cronbach’s alpha coefficients were used to verify the internal consistency of the Mental Health Problems related to Climate Change Questionnaire (MHPCCQ). Exploratory Factor Analysis (EFA) was used to examine the factor structure of MHPCCQ. A one-sample t-test, independent samples T-test, and one-way ANOVA between-groups comparisons were used to detect the differences, and the p < 0.05 statistical significance level was approved. A Scheffe test was used to identify the direction of the differences because the number of individuals in the subgroups is not equal, and compound comparisons are what the researcher wants to make. Also, the Scheffe test is one of the most flexible and statistically powerful ways to test the post-hoc multiple comparisons.

3.1Questionnaire validity

Before conducting the EFA analysis on the MHPCCQ, Bartlett’s test of Sphericity and the Kaiser-Meyer-Olkin measurement of sampling adequacy (KMO) were conducted to verify that the sample was adequate for conducting this analysis. The Bartlett’s test of Sphericity was significant (χ² = 32341.106, df = 780, p < .001) and the KMO value was acceptable at 0.907. MHPCCQ item component loads ranged from 0.358 to 0.7279. The EFA results suggest that MHPCCQ consisted of the 8-dimensional construct (Table 1).

The MHPCCQ also exhibits good reliability since the Cronbach’s alpha coefficients for the eight subscales were (0.90, 0.870, 0.819, 0.776, 0.858, 0.730, 0.720, 0.802, respectively) high. Also, the correlations between the items and the total score of the subscales were high, ranging between 0.493 to 0.846 (Table 2).

3.2Sample descriptive

The sample was constituted by 1080 subjects (n = 557, 51.57% female and n = 523, 48.43% male), mostly graduated (n = 207, 19.17% pre-university; n = 644, 59.63% graduate; and n = 229, 59.53% postgraduate) and married (n = 499, 46.20% married; n = 310, 28.70% widower; n = 140, 12.96% divorced; and n = 131, 12.13% single) coming from 18 Arab countries (Table 3).

3.3MHPCCQ scores

To determine the level of psychological problems related to climate change, the individuals were classified into three levels of MHPCC, as follows: low level from (1 to 2.33), medium level from (2.34 to 3.66), and high level from (3.67 to 5). In the same way, the individuals were classified into three levels of subscales (for example, climate fears: low level from (8–18.16); medium from (18.67 to 29.33); and high level from (29.34 to 40). The results in Table 4 indicated an average level of mental health associated with climate change in all MHPCCQ subscales and their items except item number 40.

3.4Differences in MHPCCQ due to demographic variables

The statistical analysis findings of differences in MHPCC due to gender, educational class, marital status, and the residing country are asfollows:

4.1Implications of the results

Climate change is a futuristic, past, and present problem. Therefore, it is better to think about climate change because it is a sophisticated process of long-term deterioration, which psychologists call the creeping problem. Because of this, it is necessary to face the consequences of climate change on human mental health [7, 30, 38].

Hayes et al. [32] mentioned that studying climate change’s effects on mental health helps the mental health community differentiate and predict the patterns of mental health problems, such as post-traumatic disorder, after cruel weather events. Understanding the unequal effects of climate change on marginalized groups supports public health prevention strategies to protect vulnerable persons from mental illness problems.

The Ottawa Charter in 1986 pointed out that to reach a state of physical, psychological, and social health, the person must identify and achieve ambition, fulfill his needs, and adapt to the environment. Thus, if the person loses the ability to adapt to the environment in which the outcome of climate change is failing, the ability to access the physical, psychological, and social situation, especially as economic and social services are inadequate, and sometimes the weak and absence of policies that support individuals and communities economically affected by climate change, increasing the harmful effects of climate changes on mental health [18].

In 2015, the WHO [67] developed a framework for building health systems that adapt to climate change. This framework provides guidelines for health professionals to prevent them from increasing health systems’ capacity to adapt, sustain, and strengthen in the wake of climate change. At the same time, this framework ignores the complications of mental health systems, such as the current lack of mental health infrastructure, finance, and resources [57].

The Regional Assessment Report on Disaster Risk Reduction in the Arab region of 2021 mentioned that the Arab countries face an increasing range of complex risks that interact with assertive communication and rapid transformation, offering rich opportunities for further growth and development. However, this area is simultaneously vulnerable to the challenges caused by drought, conflict, rapid urbanization, internal displacement, and migration. Climate-related hazards are increasing in frequency and severity. They are experiencing unsustainable consumption and production patterns that increase these risks, and the COVID-19 crisis is still unfolding, indicating the global nature of its multidimensional manifestations. This requires new risk governance regulations for integrated and consistent limitations.

In 2015, the 22 Arab countries adopted a Disaster Risk Reduction Penalty Framework for all United Nations member states. This framework has acquired the character of the rapidly changing and interdependent change, the growing threat of natural hazards and hazards from human activities, and the relevant biological, ecological, and technological hazards and risks. It provides a syntactic framework for a logical link between risk reduction and capacity building to address the challenges of conflict, displacement, poverty, unsustainable production and consumption patterns, climate change, and sustainable development [48].

This disaster risk reduction framework, adopted by the 22 Arab countries, did not include measures to mitigate the impact of climate change on mental health due to insufficient attention paid to mental health systems.

From the results of the current study, the following procedural framework was designed that will help mental health system workers, including policymakers, decision-makers, departments of psychology in Arab universities, as well as mental health service workers, to manage the mental health risks arising from extreme climatic changes in Arab countries:

Fig. 1

A procedural framework for policymakers, decision-makers, psychological service workers, and psychology departments to manage the risks of climate change impacts on mental health.

4.2Strengths, limitations, and future directions

This study is an epidemiological study concerned with measuring the level of MHPCC among people in the Arab world. One of the strengths of this study is its large sample (1080 selected participants from 18 Arab countries). Another strength of this study is that it is considered one of the first Arabic studies. We noted the lack of interest by Arab researchers in studying the direct and indirect effects of climate on mental health, which is another strength. Also, the current study is a comparative study of the prevalence of MHPCC among individuals from 18 Arab countries by gender, educational level, marital status, and the country where they live.

These limitations of this study include a descriptive comparative survey design that did not analyze other psychological, social, economic, and personal determinants of mental health. Therefore, the results of this study failed to demonstrate the causal links between climate change, direct and indirect impacts, and the role of other mental health determinants as mediating factors for this association. Thus, future studies on this subject must also demonstrate the long-term effects of climate change on mental health, whether longitudinal or cross-sectional, with a quantitative, qualitative, or mixed research design. We also need more intervention studies to mitigate the impact of climate change on mental health and to improve the quality of life of those negatively affected by climate change, especially the most affected groups of children, the elderly, patients with chronic diseases, people with special needs and patients with cancer tumors, be it counseling, curative or palliative care interventions.