ENVIRONMENT AND MENTAL

HEALTH

Presenter: Dr. Pooja, Dr. Shefali

Co-ordinator: Dr. Piyush
Chairperson: Dr. Rajiv Gupta
 FLOW OF THE SEMINAR
 Introduction
- Mental disease burden
- Types of environmental factors
 Impact of environment on mental health
- Positive impact
- Negative impact
 Urbanisation and mental illness
 Impact of COVID-19 on mental health
 Mental health and sustainable development goals
 Steps to promote mental health
 Conclusion
 HEALTH

 “A state of complete physical, mental and social well-being and not merely
the absence of disease or infirmity”

(WHO, 2014)

 Mental health is a state of well-being in which an individual realizes his or

her own abilities, can cope with the normal stresses of life, can work
productively and is able to make a contribution to his or her community.

(World Health Organisation)

Trends in mental health-Mental disease burden

 According to the burden of mental disorders across the states of India:

The Global Burden of Disease Study 1990–2017 – One in seven Indians
were affected by mental disorders of varying severity in 2017.

 The proportional contribution of mental disorders to the total disease

burden in India has almost doubled since 1990.

 As per Global Burden of Disease report, mental disorders accounts for

13% of total DALYs lost for Years Lived with Disability, with depression
being the leading cause.

(National Mental Health Survey, 2016)

GLOBAL DISEASE BURDEN
 ENVIRONMENT

Natural environment Built environment

Various environmental factors affecting mental health
Biological Social Physical Psychological
Genetic Lack of social Pollution Early childhood
predisposition support experiences
HPA axis Social stigma Toxins Coping skills

Culture traditions Substance abuse Early loss of

parent

Socioeconomic Chronic illness

status
Poverty Sleep deprivation
Interpersonal Extreme weather
relationships condition
Trauma
Infective agents
Nutrition
 POSITIVE IMPACT OF ENVIRONMENT ON MENTAL HEALTH

 Green space- open space area which is reserved for parks, community
gardens, playing fields, etc.

 Blue spaces- comprises all the areas dominated by waterbodies. Eg- rivers,
lakes, ponds, fountains, etc.

 Green and blue spaces can provide opportunities for social contact, thereby
enhancing social cohesion within a neighbourhood.
Pathways of nature benefits to mental health

• MITIGATION PATHWAY

• RESTORATION PATHWAY-
Stress reduction theory and
attention restoration theory

• INSTORATION PATHWAY
Pathways of nature benefits to mental health

(Markevych et al. 2017; Beute et al. 2020)

Mitigation pathway

 Mitigation means to reduce the harm by reducing the exposure to environmental

stressors. Eg. Air pollution, noise, heat.

 Air pollution concentrations are generally lower around green spaces compared to
the surrounding urban environment.

(Hirabayashi and Nowak, 2016)

 Green areas has resulted in multiple benefits such as flood risk reduction, lower air
pollution levels and improvement of temperature regulation.

 Green space in a city can decrease noise levels through acoustic shielding.

(Garg and Maji, 2014)

Restoration pathway

 Restoration refers to recovery of physiological or psychological resources

that have been diminished through the demands of dealing with everyday
life which can lead to mental and physical ill health.

 Blue spaces, especially coastal blue spaces have been found to benefit
mental health, especially due to the visual openness of the space and the
fluidity of the water

STRESS REDUCTION THEORY ATTENTION RESTORATION THEORY

Stress Reduction Theory of affective/arousal response to a natural environment

(Ulrich, 1983)
 Attention restoration theory

 Asserts that people can concentrate better after spending time in nature, or even

looking at scenes of nature.

 Vegetation and other natural-appealing environmental feature can facilitate

recovery from fatigue by attracting and holding a person’s attention without effort.

(Markevych et al, 2017)

Instoration pathway

 Green and blue spaces encourage physical activity by providing a safe,

accessible and attractive setting.

 Green spaces can improve mental health by encouraging physical activity

and facilitating social cohesion.

 Blue spaces can offer an even wider range of opportunities for physical
activities (e.g. swimming, sailing) at relatively low costs, thereby attractive
to a large proportion of the population.
 BIOLOGICAL FACTOR

MOTHER-FETUS NEUROBIOLOGICAL MODEL

 With emerging consensus that maternal psychosocial stress during

pregnancy is one probable antecedent of later anxiety disorders in
children, a new neurobiological model has arisen to explain these results.

(O’keane and Scott, 2005)

CHILDHOOD EXPERIENCE

Teasingand bullying interactions showed a connection between anxiety

disorders.

Aversive conditioning experiences such as severe teasing have been proposed

to play a role in the development of social phobia.

Asignificantly greater percentage of participants in the social phobia group

(92%) reported a history of severe teasing experiences compared with 50% in
obsessive compulsive disorder and 35% in panic disorder groups.

History
of teasing experiences was also significantly related to an earlier age
of onset for anxiety disorders.
(McCabe et al, 2003)
 Study done between the years of 1952 and 1993 and collected data
found that Americans today have significantly higher levels of anxiety.

 The average child of the 1980s had substantially more anxiety than the
child psychiatric patient of the 1950s.

 This growth in anxiety over time was correlated

- increases in measures of environmental dangers
- decreases if social connectedness present

(Twenge, 2000)
DIRECT MENTAL HEALTH EFFECTS OF THE PHYSICAL ENVIRONMENT
Environmental characterstics
High-rise housing
Residential floor level
Housing quality (structural defects,
hazards, poor maintainance, climatic
problems e..g. heat, humidity)
Neighbourhood quality (aggregate
bundle of social and physical
attributes)
Mental health impacts
Elevated psychological distress
Adults living on higher floors have
more psychological distress
Greater psychological distress in
housing of poorer quality
Greater psychological distress and
poorer cognitive development in
children
(Evans, 2003)
Environmental characterstics
Furniture placement (at social
distances, around tables)
Residential density
(people/room)
Noise (aircraft)
Indoor air quality
Light
Environmental characterstics
-Increased social interaction
-reduced passive and isolated behaviours
in psychiatric patients
More negative affect, greater
psychological distress.
Unrelated to psychiatric disorder but
elevated psychological distress in children
Malodorous pollutants linked to negative
affect. Behavioural toxins related to acting
out and agression
No reliable impacts of colour. Levels of
illumination affect depression
(Evans, 2003)
EFFECT OF POLLUTON ON MENTAL HEALTH

 To assess the exposure to air pollution and self-reported effects on Chinese

students, 55.4% respondents reported that they felt anxiety and frustration
during hazy days, when air pollution was highest.

 Of the total respondents, 44.1% reported that they became aggressive due to
haze/air pollution.

(Rajper, Ullah and Li, 2018)

Effect of air pollution on health
 The quantitative associations were investigated between particulate matter and
multiple adverse mental health outcomes (depression, anxiety, bipolar disorder,
psychosis, suicide).

 It was concluded that there is a statistically significant positive associations

between long-term PM2.5 exposure and anxiety.

(Braithwaite et al, 2019)

 Recent evidence indicates that chronic exposure to polluted air is a major

environmental risk factor for Alzheimer and dementia.

(Kilian and Kitazawa, 2018)

Impact of chronic medical illness on mental health

 Patients with chronic conditions often have to adjust their aspirations,

lifestyle and employment. Many people grieve about their predicament
before adjusting to it.

 Some have protracted distress and may develop psychiatric disorders,

most commonly depression or anxiety.

 The functional limitations imposed by the chronic medical illness may

result in distress in the patient.

(Turner and Kelly, 2000)

(Voinov B et al, 2013)
Traumatic events affecting mental health

 There are environmental risk factors for SAD identified as stressful life
events because they place increased pressure on the developing child and
potentially result in adverse outcomes.

 It is due to the purview of ‘typical’ family functioning such as divorce,

death, illness, natural disasters, changing schools, and academic failure.

 Changing schools, job loss, and financial hardships are other stressors
associated with mental health problems.
 A study of the associations of a loved one’s unexpected death with the first
onset of common mental disorders found that:
The bereavement period is associated with elevated risk for the onset of
multiple psychiatric disorders consistently across the life course and
coincident with the experience of the loved one’s death.

 Sudden loss of a loved one can trigger various mental disorders such as
-major depressive disorder
- panic disorder
- post-traumatic stress disorder
- phobias
in individuals with no history of mental illness.

(Keyes el al, 2014)

Effect of weather on mental health

 In the study, the link between extreme anxiety reactions such as post-
traumatic stress disorder and acute weather disasters such as floods,
forest fires, heat waves, storms, cyclones is well established.

(Berry et al, 2010)

 Seasonal affective disorder is a combination of biologic and mood

disturbances with a seasonal pattern, typically occurring in the autumn
and winter with remission in the spring or summer.

(Kurlansik and Ibay, 2012)

 In a given year, about 5 percent of the U.S. population
experiences seasonal affective disorder with symptoms
present for about 40 percent of the year.

(Kurlansik and Ibay, 2012)

Effect of weather on mental health
Disasters impacting adverse effect on mental health

 Disasters are large-scale events that are often unexpected and cause
death, trauma, and destruction of property.

 Disasters affect millions of people around the globe every year. There is,
on average, at least one disaster every day worldwide

 The frequency and human impact of disasters have been increasing owing
to climate change and growing population density.

(Goldmann and Galea,

2013)
 DISASTERS

• human-made,
•natural disasters nonintentional
technological disasters
the nuclear accident at
e.g., floods Chernobyl

• human-made,
intentional acts
acts such as mass violence and terrorism [e.g.,
the September 11, 2001, World Trade Center
(WTC) attacks] 
 Post-disaster burden can be substantial- It is estimated the prevalence of
PTSD is
30–40% among direct victims
10–20% among rescue workers
5–10% in the general population

 The prevalence of PTSD is also particularly high among children directly

exposed to a disaster.

(Neria Y, 2008)

 Death anxiety, panic disorder, and phobias have also been reported among
disaster victims, although few epidemiologic studies have focused on these
conditions
Toxins affecting mental health

 The relationship between prenatal exposure to BPA, phthalates and

phenols to child behaviour, emotional symptoms and behaviour disorders.

 A study found positive associations between the environmental chemicals

and child behaviour disorders.

(Philippat et al, 2017)

Cultural factors affecting mental health

 Culture may impact mental health in a variety of ways including-

 Producing mental disorders through certain child-rearing practices

 Perpetuating mental disorders by rewarding it in prestigious roles
 Producing mental illness through certain stressful roles
 Affecting the distribution of mental illness though patterns which result in
poor physical hygiene.

(Leighton and Hughes, 1961)

 Other mechanisms through which cultural factors can play a critical role in the
etiology of mental illness include-

Determining the types of coping mechanisms and resources used to mediate

stressors and treatment orientations, practices and patterns of expression of
psychopathology.

(Marsella and Yamada, 2010)

 Social factors such as exposure to racism and discrimination, violence,
poor educational achievement, and poverty can also negatively impact
mental health.

(U.S. Department of Health and Human Services, 2001)

Socio economic status affecting mental health
 Studies have consistently shown that people in the lowest strata of income,
education, and occupation are about two to three times more likely than
those in the highest strata to have a mental disorder.

(U.S. Department of Health and Human Services, 2001)

 One of the most consistently replicated findings in the social sciences has
been the negative relationship of socioeconomic status with mental
illness:
“The lower the SES of an individual is, the higher is his or her risk of mental
illness”

(Hudson, 2005)
Urban environment

 According to the latest IPBES report, urbanization can increase isolation from
nature, which in turn prevents people from harnessing the mental health
benefits of being surrounded by the natural environment.

 Poor urban environment-

 Poorly planned and managed urban settings with unsustainable transport
systems and a lack of access to public and green areas increase air pollution,
noise and heat islands.
 Reduces the opportunities for physical activity and access to decent jobs
and education
 Have a negative impact on community life and people’s physical and mental
health.

(WHO, 2020)
 The effect of the environmental factors in the urban environment is
conditional on genetic risk (i.e., there may be gene–environment interaction).

 The hypothalamic‐pituitary‐adrenal ‐axis regulates the response to stressful

events and is expected to be involved in the pathogenesis of depression.

 The glucocorticoid receptor regulates the activity of the HPA‐axis.

(Bet PM et al, 2009)

A gene–environment interaction between the GR polymorphisms 22/23EK
and 9beta and childhood adversity resulted in an increased risk of
clinically relevant depressive symptoms.

Bet PM et al, 2009

Evolution of mental health in a rapidly changing socioeconomic
environment

Heuristic model of evolution of mental health in India

 Mental health issues like loneliness (17.3% vs. 9.8%), worry (17.3% vs.
10.7%), and suicidal thoughts (19.2% vs. 14.1%) were higher among urban
students.

 Physical fight (53.8% vs. 11.6%), bullying (46.4% vs. 17%), physical attack
by family members (46% vs. 17%) and by teachers (53% vs. 10.7%) were
all more in urban adolescents.

 Mental health and violence-related issues were prevalent more among

urban students than those among rural students in spite of having more
protective factors suggesting the need of frequent supervision, monitoring
and support of adolescents.
(Samanta et al., 2014)
 In a study to estimate the prevalence and correlates of mental disorder,
out of 2048 adolescents, the prevalence of mental illness was 1.81%.

 The most common diagnoses were

- anxiety disorders (1.0%)
- depressive disorder (0.5%)
- behavioural disorder (0.4%)
- attention-deficit hyperactivity disorder (0.2%)

 Adolescents from urban areas and girls who faced gender discrimination
had higher prevalence.

(Pillai A et al, 2008)

 The final multivariate model found an independent association of mental
disorders with an outgoing ‘non-traditional’ lifestyle.

 Having one’s family as the primary source of social support was associated
with lower prevalence of mental disorders.

(Pillai A et al, 2008)

URBANISATION AND SCHIZOPHRENIA

  Around one-third of all schizophrenia incidence may be related to

unknown but likely unconfounded environmental factors operating in the
urban environment.

 Evidences suggests that causation (urban environment causes psychosis)

is more important than selection (high-risk individuals move into urban
areas)

(Krabbendam and Os, 2005)

URBANISATION AND DEPRESSION

 In a study among 1355 respondents, residence in neighbourhoods

characterised by a poor quality built environment was associated with greater
individual likelihood of past six month and lifetime depression.

 29%–58% reported past six month depression.

 36%–64% reported lifetime depression than respondents living in

neighbourhoods characterised by better features of the built environment.

(Galea S et al, 2005)

 EFFECT OF COVID-19 ON MENTAL HEALTH

 Many psychological problems and important consequences in terms of

mental health including stress, anxiety, depression, frustration,
uncertainty during COVID-19 outbreak emerged progressively.

  The psychological reactions to COVID-19 pandemic may vary from a

panic behavior or collective hysteria to pervasive feelings of
hopelessness and desperation which are associated with negative
outcomes including suicidal behavior.
(Serafini G et al, 2020)
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 Quarantine and self‐isolation can most likely cause a negative impact on one's
mental health.

 The separation from loved ones, loss of freedom, boredom, and uncertainty
can cause a deterioration in an individual's mental health status.

(Yao H et al, 2020)

 In a cross-sectional study on 398 population to see the psychological impact of

lockdown restrictions and quarantine due to global infections- The mean post-
traumatic stress scores were four times higher in children who had been
quarantined relative to those who were not quarantined.

(Sprang and Silmon, 2013)

 Elderly people are more prone to the COVID‐19 outbreak due
to both clinical and social reasons such as having a weaker
immune system or other underlying health conditions and
distancing from their families and friends due to their busy
schedules.

(Javed B et al, 2020)

 Family members witnessed the following changes to the behavior of older
relatives-
- Irritating and shouting behavior

- Change in their sleeping and eating habits

- Emotional outbursts

(World Economic Forum 2020)

 Millennium Development Goals

 The United Nations Millennium Declaration, signed in September 2000,

commits world leaders to combat poverty, hunger, disease, illiteracy,
environmental degradation and discrimination against women.

  Each MDG has targets which were set for 2015.

 Despite the MDG's success in reducing the overall health gap between
rich and poor countries and considerable achievements for infectious
diseases such as malaria or HIV/AIDS but this generation of development
goals did not include any reference to mental illness.
 SUSTAINABLE DEVELOPMENT GOALS

In September 2015, mental health was included in the UN

Sustainable Development Goals.
 The UN further recognises mental illness as a major challenge
for sustainable development and expresses its commitment to
the prevention and treatment of non-communicable diseases,
including behavioural, developmental and neurological
disorders. 
Mental Health and Sustainable Development goals
 Within the health related SDGs, two targets are directly related to mental
health and substance abuse.

 Target 3.4 “By 2030, reduce by one third premature mortality from Non
communicable diseases through prevention and treatment and promote
mental health and well-being.”

 Target 3.5 requests countries: “Strengthen the prevention and treatment

of substance abuse, including narcotic drug abuse and harmful use of
alcohol.”
 Mental health is a priority for global development for the next 15 years.

 On the road to this achievement, many individuals and organisations have

played a role in contributing to the inclusion of mental health in the SDGs.

 one of which is the global initiative called FundaMentalSDG.

 This group has urged the UN to include mental health in the new
development goals, targets and indicators.
 
Specific ways to promote mental health include:

 early childhood interventions (e.g. providing a stable environment that is

sensitive to children’s health and nutritional needs, with protection from
threats, opportunities for early learning, and interactions that are
responsive, emotionally supportive and developmentally stimulating)

 support to children (e.g. life skills programmes, child and youth

development programmes).
 social support for elderly populations (e.g. befriending initiatives,
community and day centres for the aged)

 programmes targeted at vulnerable people, including minorities,

indigenous people, migrants and people affected by conflicts and disasters
(e.g. psycho-social interventions after disasters)

 mental health promotional activities in schools (e.g. programmes involving

supportive ecological changes in schools)

 mental health interventions at work (e.g. stress prevention programmes)

 Housing policies (e.g. housing improvement)

 Violence prevention programmes (e.g. reducing availability of alcohol and

access to arms)

 Community development programmes (e.g. integrated rural

development)

 Poverty reduction and social protection for the poor

 Physical health factors are also associated with mental illness. The physical
and mental health both have a significant influence on an individual’s
overall quality of life or general well-being.

 Good physical health and healthy behaviors can positively affect mental
health.

 For example, exercise or physical activity has particularly prominent

mental health benefits in individuals with elevated levels of depression
and anxiety.
 The positive changes in depression, anxiety, and mood states following exercise
are due to endorphin and monoamine mechanisms and potentially increases in
blood circulation in the brain and impacts on physiological reactivity to stress.

 Besides reducing depression, anxiety, and negative mood, exercise can also
improve self-esteem and cognitive functioning.

(Callaghan P, 2004)
CONCLUSION

 Burden of mental disorder seen by the world is only a tip of iceberg. So, to
promote the mental health there is a need to create such living conditions
and environment that support the mental health and allow the people to
adopt and maintain health lifestyle.

 National mental health policies should not be solely concerned with

mental disorders but should also recognize and address the broader issues
like environment, housing, etc.
 It is increasingly recognized that prodrome of many mental disorders start
at an early stage. Therefore, aim should be improving the child
development by early childhood interventions like pre-school psychosocial
activities, nutritional and psychosocial help to give roots for a healthy
community.
Thank you