{"id":49044,"date":"2020-11-16T15:42:35","date_gmt":"2020-11-16T14:42:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=49044"},"modified":"2020-11-16T15:53:28","modified_gmt":"2020-11-16T14:53:28","slug":"mental-health-in-water-scarce-cities-an-unrecognized-climate-change-pressure-point","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/11\/16\/mental-health-in-water-scarce-cities-an-unrecognized-climate-change-pressure-point\/","title":{"rendered":"Mental health in water scarce cities: an unrecognized climate change pressure point"},"content":{"rendered":"

Water unavailability is one of many linked stressors increasingly likely to affect mental health in some city populations. Azar M Abadi and colleagues consider the evidence and propose steps forward to protect vulnerable residents<\/em><\/p>\n

<\/p>\n

Several megatrends, including climate change, urbanization, and water stress, are converging to put additional strain on global mental health. The impact of water scarcity on mental health has been well characterized for rural populations<\/span>;1<\/sup> the nexus at the intersection of water scarcity and mental health for urban dwellers deserves closer examination.\u00a0<\/span><\/p>\n

Mechanisms may include stress and insecurity felt due to water scarcity; displacement of families to urban areas; effects of dehydration on effectiveness of psychoactive medications; heat-related aggression, violence, and suicide; and high mental burden on women for their efforts to find and procure clean water.\u00a0<\/span><\/p>\n

Water scarcity also contributes to mental health through myriad indirect pathways including land degradation, famine, malnutrition, spread of disease, heat waves, and reduced air quality. Highly correlated stressors associated with water insecurity in urban settings mean that water stress is unlikely to be identified as a principal cause for mental illness.<\/span><\/p>\n

Pathways linking water stress and mental health disorders<\/b><\/p>\n

Urban migration is a common coping strategy for rural people exposed to drought. In this context, depression and anxiety resulting from the rupture of community and place bonds is a likely causal pathway.1 <\/sup><\/span>Migration, particularly early in the life cycle, is a significant risk factor for several mental disorders.2<\/sup><\/span><\/p>\n

The impact of migration on mental health is greater among women, youth, elderly people, and people with disabilities.3<\/sup> <\/span>Compromised mental health in caregivers or parents is likely to directly influence not only concurrent child wellbeing but also developmental trajectories of child mental health thereafter.<\/span>\u00a0<\/span><\/p>\n

Several studies link poor water access and quality to adverse mental health in urban settings, including in Iran;4<\/sup><\/span> Bolivia;5<\/sup><\/span> and the United States.6 <\/sup><\/span>Women are at particular risk, studies in Bolivia,7 <\/sup><\/span>urban Nepal,8 <\/sup><\/span>and Odisha, India,9<\/sup><\/span> have concluded.\u00a0<\/span><\/p>\n

Climate change is increasing the frequency of compound hazards, wherein heat and water stress overlap.10 <\/sup><\/span>Myriad studies have found high ambient temperatures associated with mental and behavioural disorders. Older people are more vulnerable to extreme heat.11 <\/sup><\/span>Existing mental health issues like schizophrenia, schizotypal disorders, neurotic disorders, and disorders related to substance misuse are associated with increased morbidity and mortality at higher temperatures.3,12 <\/sup><\/span>Lower socioeconomic status, homelessness, and living in slums were associated with adverse mental health outcomes in hot cities.13<\/sup><\/span><\/p>\n

Evidence informed solutions<\/b><\/p>\n

Optimum management is likely to include strategies to manage water insecurity in urban settings,21<\/sup><\/span>\u00a0increased mental health surveillance and service delivery, and protecting the most vulnerable people from the combined stressors that can exacerbate mental health concerns.\u00a0<\/span><\/p>\n

Focusing on interventions that are likely to benefit mental health is particularly important. Limited access to green and blue space can compromise mental health.<\/span> Diminished active spaces exacerbates physical and mental health conditions.14<\/sup><\/span> Management of urban green spaces in wealthy and poor neighbourhoods is central,15 <\/sup><\/span>as is maintenance of and access to urban waterways.16<\/sup><\/span><\/p>\n

Sustained access to clean water is a key health determinant. Like other determinants, access tends to vary across familiar inequity gradients. Recognition of the impact of upstream drivers, such as neighbourhood conditions or household financial status, and the differential impact on marginalized populations, is key.17<\/sup><\/span><\/p>\n

Some water and sanitation management strategies could exacerbate mental health threats. Recognizing the many hydro-social contracts that affect health between water managers and urban residents can help reduce harms. Recognizing the human right to clean, safe water has important implications for reducing harms.18 <\/sup><\/span>Water management strategies need to be flexible and responsive. For example, a study in Australia reported that permanent water restrictions are not viable long-term policy.19 <\/sup><\/span>In addition, indiscriminate use of water pricing strategies to restrict demand, without consideration of impacts on economically vulnerable populations, is likely to worsen stresses and undermine mental health.20<\/sup><\/span><\/p>\n

Education, in health and water sectors and of the general population, is important. For example, health counselling about extreme temperatures can be included in the outpatient care program for patients with mental disorders.\u00a0<\/span><\/p>\n

Existing global mental health priorities highlight the need for a life-cycle approach and early interventions. Existing priorities also emphasize approaches that integrate family members and communities, and wrap-around services should incorporate water insecurity into mental health programming.<\/span><\/p>\n

More research needed<\/b><\/p>\n

Evaluation and research are crucial to identify vulnerable populations and risks. More research, data collection, and mental health surveys are needed to create larger databases in real time and to identify vulnerable populations and allocate more funding to make these populations more resistant to water insecurity.\u00a0<\/span><\/p>\n

Climate change, urbanization, and water stress present challenges to livelihoods and services, from mental health surveillance and treatment provision to water sourcing to sanitation, that are already under significant strain. Climate change has the potential to amplify trends and conditions that already strain systems to monitor and tackle population health challenges. These systems need to be updated to respond to looming additional burdens.\u00a0<\/span><\/p>\n

Thoughtful, proactive investments could blunt many of the worst effects. As with many other climate change impacts, however, there is worrisome potential for the world\u2019s most vulnerable to suffer most.<\/span><\/p>\n

Azar M. Abadi<\/strong>, PhD, University of Nebraska Medical Center, USA<\/em><\/p>\n

Ann Vander Stoep<\/strong>, PhD, MS, University of Washington, USA<\/em><\/p>\n

Katherine T. Foster<\/strong>, PhD, University of Washington, USA<\/em><\/p>\n

Susan Clayton<\/strong>, PhD, College of Wooster, USA<\/em><\/p>\n

Jesse E. Bell<\/strong>, PhD, Omaha, USA<\/em><\/p>\n

Jeremy Hess<\/strong>, MD, MPH, University of Washington, USA<\/em><\/p>\n

This article is part of a series commissioned by\u00a0The BMJ\u00a0for the World Innovation Summit for Health (WISH) 2020.\u00a0The BMJ\u00a0peer reviewed, edited, and made the decisions to publish. The series, including open access fees, is funded by WISH.<\/span><\/em><\/p>\n

References:<\/strong><\/p>\n

    \n
  1. Vins H, Bell J, Saha S, Hess JJ. The Mental Health Outcomes of Drought: A Systematic Review and Causal Process Diagram. Int J Environ Res Public Health [Internet]. 2015 Oct 22;12(10):13251\u201375. Available from: <\/span>http:\/\/dx.do<\/span>i<\/span>.org\/10.3390\/ijerph121013251<\/span><\/li>\n
  2. Gaber TJ, Bouyrakhen S, Herpertz-Dahlmann B, Hagenah U, Holtmann M, Freitag CM, et al. Migration background and juvenile mental health: a descriptive retrospective analysis of diagnostic rates of psychiatric disorders in young people. Glob Health Action [Internet]. 2013 Jun 19;6:20187. Available from: <\/span>http:\/\/dx.doi.org\/10.3402\/gha.v6i0.20187<\/span><\/li>\n
  3. Berry HL, Waite TD, Dear KBG, Capon AG, Murray V. The case for systems thinking about climate change and mental health. Nat Clim Chang [Internet]. 2018 Apr 3 [cited 2020 Sep 12];8(4):282\u201390. Available from: <\/span>https:<\/span>\/<\/span>\/www.nature.com\/articles\/s41558-018-0102-4<\/span><\/li>\n
  4. \u017denko M, Menga F. Linking Water Scarcity to Mental Health: Hydro\u2013Social Interruptions in the Lake Urmia Basin, Iran. Water [Internet]. 2019 May 24 [cited 2020 Jun 27];11(5):1092. Available from: <\/span>https:\/\/www.mdpi.com\/2073-4441\/11\/5\/1092<\/span><\/li>\n
  5. Wutich A, Brewis A, Chavez JBR, Jaiswal CL. Water, worry, and Do\u00f1a Paloma: why water security is<\/span> fundamental to global mental health. In: Global mental health [Internet]. Routledge; 2016. p. 57\u201372. Available from: <\/span>https:\/\/books.google.com\/books?hl=en&lr=&id=ymiTDAAAQBAJ&oi=fnd&pg=PA57&dq=water+mental+health&ots=DPV-nd8muS&sig=X5Om3GyUJ4aNpBCW1I-1yGBEzq4<\/span><\/li>\n
  6. Maxfield A. Testing the theoretical similarities between food and water insecurity: Buffering hypothesis and effects on mental wellbeing. Soc Sci Med [Internet]. 2020 Jan;244:112412. Available from: <\/span>http:\/\/dx.doi.org\/10.1016\/j.socscimed.2019.112412<\/span><\/li>\n
  7. Wutich A, Ragsdale K. Water insecurity and emotional distress: coping with supply, access, and seasonal variability of water in a Bolivian squatter settlement. Soc Sci Med [Internet]. 2008 Dec;67(12):2116\u201325. Available from: <\/span>http:\/\/dx.doi.org\/10.1016\/j.socscimed.2008.09.042<\/span><\/li>\n
  8. Aihara Y, Shrestha S, Sharma J. Household water insecurity, depression and quality of life among postnatal women living in urban Nepal. J Water Health [Internet]. 2016 Apr;14(2):317\u201324. Available from: <\/span>http:\/\/dx.doi.org\/10.2166\/wh.2015.166<\/span><\/li>\n
  9. Hulland KRS, Chase RP, Caruso BA, Swain R, Biswal B, Sahoo KC, et al. Sanitation, Stress, and Life Stage: A Systematic Data Collection Study among Women in Odisha, India. PLoS One [Internet]. 2015 Nov 9;10(11):e0141883. Available from: <\/span>http:\/\/dx.doi.org\/10.1371\/journal.pone.0141883<\/span><\/li>\n
  10. Sharma S, Mujumdar P. Increasing frequency and spatial extent of concurrent meteorological droughts and heatwaves in India. Sci Rep [Internet]. 2017 Nov 14;7(1):15582. Available from: <\/span>http:\/\/dx.doi.org\/10.1038\/s41598-017-15896-3<\/span><\/li>\n
  11. \u00c5str\u00f6m DO, Forsberg B, Rockl\u00f6v J. Heat wave impact on morbidity and mortality in the elderly population: a review of recent studies. Maturitas [Internet]. 2011 Jun;69(2):99\u2013105. Available from: <\/span>http:\/\/dx.doi.org\/10.1016\/j.maturitas.2011.03.008<\/span><\/li>\n
  12. Ho HC, Wong MS. Urban environmental influences on the temperature\u2013mortality relationship associated mental disorders and cardiorespiratory diseases during normal summer days in a subtropical city. Environ Sci Pollut Res [Internet]. 2019 Aug 1;26(23):24272\u201385. Available from: <\/span>https:\/\/doi.org\/10.1007\/s11356-019-05594-0<\/span><\/li>\n
  13. Schmeltz MT, Gamble JL. Risk characterization of hospitalizations for mental illness and\/or behavioral disorders with concurrent heat-related illness. PLoS One [Internet]. 2017 Oct 16;12(10):e0186509. Available from: <\/span>http:\/\/dx.doi.org\/10.1371\/journal.pone.0186509<\/span><\/li>\n
  14. Liu H, Li F, Li J, Zhang Y. The relationships between urban parks, residents\u2019 physical activity, and mental health benefits: A case study from Beijing, China. J Environ Manage [Internet]. 2017 Apr 1;190:223\u201330. Available from: <\/span>http:\/\/dx.doi.org\/10.1016\/j.jenvman.2016.12.058<\/span><\/li>\n
  15. Fuller RA, Irvine KN, Devine-Wright P, Warren PH, Gaston KJ. Psychological benefits of greenspace increase with biodiversity. Biol Lett [Internet]. 2007 Aug 22;3(4):390\u20134. Available from: <\/span>http:\/\/dx.doi.org\/10.1098\/rsbl.2007.0149<\/span><\/li>\n
  16. Dean J, van Dooren K, Weinstein P. Does biodiversity improve mental health in urban settings? Med Hypotheses [Internet]. 2011; Available from: <\/span>https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0306987711000910?casa_token=wu89VR_MX_4AAAAA:UBwXYaZK5wDkkrFo-GZTUt7-u6njwNK-PaKj7cZXgUT5saI2droKSIHmfbvH-dQeBfP7iz9k-X0<\/span><\/li>\n
  17. Barten F, Mitlin D, Mulholland C, Hardoy A, Stern R. Integrated approaches to address the social determinants of health for reducing health inequity. J Urban Health [Internet]. 2007 May;84(3 Suppl):i164\u201373. Available from: <\/span>http:\/\/dx.doi.org\/10.1007\/s11524-007-9173-7<\/span><\/li>\n
  18. Bluemel EB. The implications of formulating a human right to water. Ecology LQ [Internet]. 2004;31:957. Available from: <\/span>https:\/\/heinonline.org\/hol-cgi-bin\/get_pdf.cgi?handle=hein.journals\/eclawq31&section=42&casa_token=RsAlBJuX1sMAAAAA:CenBtRtlgtfrZz1ysyDzD4-uRlT63hJcbLskHoiyPI8gi0sf3SEXKQj_YEcXlTkOVjMzR5OL<\/span><\/li>\n
  19. Allen Consulting Group. Saying Goodbye to Water Restrictions in Australia\u2019s Cities: Key Priorities for Achieving Water Security. A Report to Infrastructure Partnerships. 2007;<\/span><\/li>\n
  20. Fass SM. Water and poverty: implications for water planning. Water Resour Res [Internet]. 1993;29(7):1975\u201381. Available from: <\/span>https:\/\/agupubs.onlinelibrary.wiley.com\/doi\/abs\/10.1029\/92WR02993@10.1002\/(ISSN)1944-7973.DEVCTRY1?casa_token=TSww2ke0mdoAAAAA:evPN22ZvjfwUbifMZy4BAirjwFhfW0bJw3587-Fp1-czP8BcAktbhY6M_6mDSON7BigHWoPosKXWnOM<\/span><\/li>\n
  21. Frumkin Howard, Das Maitreyi Bordia, Negev Maya, Rogers Briony C, Bertollini Roberto, Dora Carlos et al. Protecting health in dry cities: considerations for policy makers BMJ 2020; 371 :m2936<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Water unavailability is one of many linked stressors increasingly likely to affect mental health in some city populations. Azar M Abadi and colleagues consider the evidence and propose steps forward […]<\/p>\n

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