Italy is arguably one of the most popular vacation destinations all year-round, and particularly during the summer period. However, the state’s environmental blessing is actually turning into a climate curse. Italy is, in fact, at the epicentre of this soon-to-be hell on Earth. The United Nations Environment Programme (UNEP) states that “the Mediterranean region is warming up 20% faster than the global average” (UNEP, 2020). This has a number of environmental consequences, including heat waves, coastal erosion, fires, floods, acidification of the sea and invasive species.
Many Italian people have experienced first-hand one or many of these adverse outcomes. As reported by Italian broadcast and newspapers, fairly recently many Northern Italian regions displayed a near-apocalyptic scenario, as a heavy storm destroyed a number of buildings and cut down hundreds of trees (RaiNews, 2023). At the other end of the spectrum; scorching heatwaves in the Central and Southern areas of the country were enough to discourage many people from choosing those regions as the ideal holiday spots (La Repubblica, 2023).
These climate events also have consequences on the physical health of people, sometimes with fatal results, such as in the case of very intense heatwaves and floods. However, what has not been sufficiently discussed is the impact that these events have on people’s mental health. A few months ago, we wrote a blog on a paper by Monsour and colleagues (2022) that found an association between climate change events in Florida, United States (US), and the prevalence of mental health symptoms such as post-traumatic stress disorder (PTSD), anxiety, and major depressive disorder. While the climate crisis is a global crisis, it does not affect every area similarly. Nor does it affect all people in the same way. In that light, what do the findings in the US tell us about Europe? Do we see a similar association, and specifically in at-high risk countries such as Italy?
Thankfully, Massazza, Ardino and Fioravanzo (2023) helped answer this very relevant question by reviewing the available literature on the relationship between climate change and mental health in Italy. And if you are wondering “what about the other Mediterranean countries such as Spain, Greece, and Croatia?”, the authors highlighted that the findings of this review are likely to apply to those countries, too, due to the similarities of both environment and climate.
Italy is one of the European areas majorly hit by the climate crisis due to intense heatwaves and floods, but the effect on people’s mental health is less clear.
Methods
All details of the authors’ methodology are summarised as following:
- Protocol: Missing.
- Guidelines: PRISMA ScR and Joanna Briggs Institute manual for scoping reviews.
- Databases: MEDLINE, Global Health, Embase, and PsycINFO (Ovid).
- Search strategy: climate change and climate change stressors, mental health, and Italy.
- Screening: AI platform Rayyan for systematic reviews (Ouzzani, Hammady, Fedorowicz, & Elmagarmid, 2016).
- Inclusion criteria: relationship between climate change and climate change stressors and mental health, Italy, English/Italian language, peer-reviewed
- Quality: NIH Quality Assessment Tool for Case-Control Studies and the one for Observational Cohort and Cross-Sectional Studies (National Institute of Health, 2021).
- Summary: narrative synthesis according to type of climate exposure.
Results
This review included 21 studies (from 1997 to 2021), mainly focusing on the northern-centre regions of Italy and Sicily. Most studies were cross-sectional or time-series, while the rest had a case-crossover, case-control, and cohort study design. Of note, all but one study (which used mixed-methods) was quantitative.
The vast majority of the studies focused on three outcome measures, and for each of these the results were reported:
Temperature
- High mortality rates, especially in older adults;
- Suicide attempts (mixed results for sex and season);
- Associations with bipolar disorder and mixed findings with anxiety, mood disorders, and psychosis;
- Association with increase in psychiatric-related calls in the summer.
Extreme weather events
- Associations between floods and full and sub-threshold PTSD several years after the flood occurred;
- Consequent worry about future floods.
Climate change perceptions
- Weak correlation with emotional disorders in African migrants in Italy.
As for the quality of the studies, many of the papers failed to adjust for relevant confounders, did not use appropriate measurements for exposures and/or outcomes, and did not consider whether the analyses had enough power.
Most of the included studies focused on the effects of temperature on mental health including mortality, self-harm and affective disorders.
Conclusions
The review provides evidence that intense temperature and heatwaves represent an important risk factor, threatening the lives of people with pre-existing mental health issues, whereas findings on suicide are less unanimous. The results on floods and mental health, especially PTSD, corroborate those from existing evidence.
The findings indicate an association between temperature, extreme weather events, and climate change perceptions with worse mental health.
Strengths and limitations
This scoping review is helpful in highlighting the lack of evidence, as well as the gaps in the current literature from Italy (particularly from the South), despite it being one of the main countries suffering from the climate change in Europe. For instance, the authors rightfully pointed out that many of the included studies did not account for the effect of other variables in the relationship between climate crisis and mental health. Moreover, these studies did not cover other relevant climate events such as wildfires, which are increasingly common in the Mediterranean countries. Of note, despite one of the main focuses of the review being trauma and PTSD, not many papers directly investigated them in relation to the climate.
Besides these gaps, we believe that other considerations should be made. For instance, all studies but one used quantitative data, whereas more qualitative data would have been informative to understand people’s perspective on climate change and their mental health. Additionally, many studies were conducted in older people – are we seeing the same effects in younger samples? And do the results differ depending on other factors? On this note, the study of Monsour et al. (2022) found differences in economic status and ethnic background – are certain parts of the population also more heavily affected by the climate crisis in Italy? And does this depend on the differences in population and wealth distribution, besides the diverse landscape? For instance, given that healthcare infrastructure can mitigate the negative effect of climate disasters on health, specific areas that are more developed might be more effective in mitigating health issues.
There are some concerns about the methodology used for this review, too. It is good practice to publish the protocol before proceeding with the screening of the studies, however, to our knowledge this does not seem to be something the authors have completed. Also, the authors argue that a meta-analysis was not carried out because “studies were too heterogeneous” – given that 17 out of 21 studies focused on temperature, perhaps the data could have still been analysed in a more systematic way. Finally, two studies were included in the review because they mentioned trauma in their introduction, but it is unclear whether these studies provided original findings on trauma.
This review highlights that more evidence is needed, as many other questions about climate crisis and mental health remain unanswered.
Implications for practice
As mentioned, this review highlights the lack of research papers focusing on the effects of the climate crisis on mental health. Similarly, it provides further reasons for concern, thus calling for more research on this topic. Even more importantly, we feel that the findings of such research should reach other people besides academics. For instance, it is crucial that an awareness of the consequences of the climate crisis reaches healthcare professionals, such as GPs, psychotherapists, and clinical psychologists. Not only could this help better identify the causes of mental health problems and their worsening, but it could also lead to a better understanding of the potential consequences of the climate crisis.
However, it goes without saying that the best way to prevent these adverse outcomes from happening is reducing the devastating effects of the climate at the root, such as by diminishing the impact of fossil fuel. For instance, Italy’s fossil fuel company ENI should show a leading role in the energy transition. Otherwise, they are contributing to the suffering of their own people. Besides, a report from Greenpeace and ReCommon showed that ENI already knew in the 1970’s that CO2 contributed to the warming of the planet (Greenpeace & ReCommon, 2023).
The hope is that, by acknowledging the climate crisis as a health crisis and, therefore, also a mental health crisis, high-risk countries such as Italy will not become the centre of continuous natural disasters and ever-worsening mental health problems.
It is crucial that more awareness is raised towards the consequences of the climate crisis, including poor mental health.
Statement of interests
None.
Links
Primary paper
Massazza A, Ardino V, Fioravanzo RE. Climate change, trauma and mental health in Italy: a scoping review. Climate change, trauma and mental health in Italy: a scoping review. European journal of psychotraumatology. 2022 Jul 29;13(1):2046374.
Other references
Greenpeace & ReCommon. ENI knew. 2023. https://www.greenpeace.org/static/planet4-italy-stateless/2023/09/1771a200-eni_knew_ok.pdf
Monsour M, Clarke-Rubright E, Lieberman-Cribbin W, Timmins C, Taioli E, Schwartz RM, Corley SS, Laucis AM, Morey RA. The impact of climate change on the prevalence of mental illness symptoms. Journal of Affective Disorders. 2022 Mar 1;300:430-40.
National Institute of Health. Study quality assessment tools. 2021. https://www.nhlbi.nih.gov/health-topics/
Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan–a web and mobile app for systematic reviews. Systematic reviews. 2016 Dec;5:1-0.
La Repubblica. 2023. https://www.repubblica.it/viaggi/2023/07/18/news/caldo_migrazione_turismo_estivo_verso_nord-408160954/
UNEP. Climate change in the Mediterranean. 2020. https://www.unep.org/unepmap/resources/factsheets/climate-change
Photo credits
- Photo by Luca Micheli on Unsplash
- UNEP. Climate change in the Mediterranean. 2020. https://www.unep.org/unepmap/resources/factsheets/climate-change
