Authors: Jurjen J. Luykx, Christiaan H. Vinkers and Joeri K. Tijdink
Climate change may bring about anxiety, which may be referred to as eco-anxiety. Commonly accepted conceptual or diagnostic criteria for eco-anxiety are currently lacking. Here, we briefly summarise the current literature on climate change and mental illness. We suggest dividing the concept of eco-anxiety into adaptive eco-anxiety and an anxiety disorder where climate change plays a major role. This distinction may be helpful in clinical practice to discern relatively common and potentially healthy eco-anxiety from a disorder causing impairment in daily functioning. Benefits of adaptive eco-anxiety include the development of active coping strategies (increasing resilience) as well as behavioural changes to mitigate climate change. When debilitating anxiety comes with avoidance and centres around climate change, a specific phobia called eco-anxiety disorder may be considered. Importantly, as validated diagnostic criteria for this disorder are currently lacking, further conceptualisation is highly needed. Future clinical research may help fill these current knowledge gaps.
Conflict of interest and financial support: none declared.
Our mental well-being can be affected by climate change in several ways. One of the possible consequences is ‘eco-anxiety’. What is now known about this anxiety? And is it always problematic, or can it also be adaptive?
A 42-year-old woman with generalised anxiety disorder comes to the surgery with an increase in anxiety symptoms. The GP notes that she experiences a deep-seated pessimism about climate change and wonders whether it is solastalgia or eco-anxiety (‘eco-anxiety’; see the next section for definitions of these terms).
But is there evidence for the emergence of a ‘new’ psychiatric disorder due to climate change? And how should GPs, psychiatrists and other clinicians diagnose and treat such a disorder? In this commentary, we consider these questions.
To find answers to these questions, we conducted a brief literature search on climate change and psychological complaints. Our search in PubMed was as follows: ‘(“climate change” OR pollution OR deforestation OR global warming) AND (mental health OR depression OR psychosis OR anxiety OR PTSD OR bipolar disorder OR ADHD OR autism OR dementia )’.
This search resulted in 1045 articles on 11 November 2022. So there is a lot to do about climate change and its impact on our mental health.
Climate change and mental health symptoms
Climate change can cause mental health complaints through many routes. Think of depression luxuriating because family members died due to drought, or more psychological processes such as daily worry and anxiety due to climate change. In the Netherlands, as far as the latter is concerned, the main issue is fear of floods and droughts: one in three Dutch people think the country will be uninhabitable in over a hundred years’ time as a result. A wide range of scenarios can give rise to psychological complaints, from acute and threatening situations (such as a flood) to climate processes that gradually make people’s existence more uncertain.
So far, scientific research on climate change and mental health has mainly focused on the effects of heat waves, forest fires, floods and drought. For example, heat waves can make people more likely to be aggressive and suicidal,5 with one study finding, incidentally, that in areas with lots of greenery, there seems to be almost no link between heat waves and aggression.
Furthermore, a relationship has been shown between temperature increase (independent of climate change) and substance use disorders, anxiety disorders and depression.7 A 20-40% increase in depressive disorders, anxiety disorders and PTSD has been found among people living in areas with a lot of forest fires and floods. The effects of long-term processes – such as drought – are obviously more difficult to investigate.
Furthermore, it may be valuable to look at the psychological processes and emotions that mediate psychological complaints related to climate change. A large-scale study found that such psychological complaints in young people are mainly related to feelings of guilt.
Finally, it has been shown that media coverage can trigger anxious feelings associated with climate change. On the other hand, it has been found that mild anxiety associated with climate change can increase willingness to act to mitigate climate change.
Can we better conceptualise eco-anxiety?
The above examples describe how noticeable climate change affects our lifestyles and can lead to psychological symptoms. What about fear of climate change and of the consequences of climate change (eco-anxiety)? What is known about the concept of eco-anxiety and what should you know about it as a GP, psychiatrist, paediatrician or other doctor?
Eco-anxiety is anxiety that arises from awareness of the irreversible impact of climate change on the environment.11 Eco-anxiety is similar to the concept of solastalgia, but it is more specific. Solastalgia is derived from solacium (consolation) and -algia (pain) and can be understood as emotional or existential pain as a result of changes that take place in the living environment.12 This may involve a multitude of changes, for example due to mine construction or drought. These changes may be related to climate change, but they may also be unrelated. Eco-anxiety, on the other hand, specifically involves anticipation anxiety about the consequences of climate change.
Our literature review did not reveal any validated criteria of psychiatric illness specifically due to climate change. To our knowledge, no studies are available that have examined clinical features and suggested a validated diagnosis. Moreover, eco-anxiety can also be a normal emotion that can contribute positively to climate change mitigation, as long as it does not limit functioning or cause persistent suffering. Indeed, this eco-anxiety can provide active, adaptive coping that prepares a person for climate change. Moreover, eco-anxiety can help combat climate change by prompting people, for example, to engage in activities that reduce their personal ecological footprint, or in societal actions that promote climate-conscious behaviour and policies.
The DSM, the diagnostic manual in psychiatry, does not list a disorder specifically related to climate change. However, eco-anxiety could take the form of a specific anxiety disorder, which is a condition that does appear in the DSM. Specific anxiety disorders are prolonged, excessive forms of anxiety focused on a single situation or object. They are associated with avoidance and with significant suffering or impaired functioning.
How to proceed with eco-anxiety?
From our limited literature review, it emerges that there is considerable attention to the psychological effects of climate change and possible treatments. However, the found articles and special journal editions devoted to psychological complaints due to climate change pay little or no attention to conceptualising the concept of eco-anxiety.13 The division into ‘healthy’ adaptive eco-anxiety and an ‘unhealthy’ eco-anxiety as a specific anxiety disorder as we propose provides nuance and may avoid speech confusion.
In the coming years, we believe the criteria of ecoanxiety may be investigated through field research, for instance by examining prevalence, clinical features and ‘interrater reliability’. It is also necessary to investigate what the differential diagnosis in such patients is: in people whose anxiety appears to be more generalised, is it still a generalised anxiety disorder? Incidentally, a recent study of Germans from the general population shows that the degree of eco-anxiety is limited; on average, participants scored 2 on the ‘Climate Anxiety Scale’ (score range: 1-7; the higher, the more severe).14 It would be interesting to investigate whether people with a high score meet the criteria for a specific phobia and how symptoms develop over time.
In the meantime, panic about eco-anxiety is unnecessary. What is urgent, however, is the issue of how we deal with the approaching climate change, which is partly caused by the care we provide.2 For the clinician-practitioner, such as the GP in the case study at the beginning of this article, the motto remains: investigate whether there may be an anxiety disorder in a classificatory sense, i.e. paired with avoidance on the one hand and reduced functioning or high suffering on the other. If both are met, there may be a climate change-related anxiety disorder that may require treatment.
Online article and comment at ntvg.nl/D7410
Cite as: Ned Tijdschr Geneeskd. 2023;167:D7410
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