Article
The Impact of Extreme Heat Periods on Health Care Utilization due to Mental Health Disorders – a Systematic Review
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Authors
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Jan Stratil
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Lára R. Hallsson
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Milena Muehler
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Sonja Rossmann
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Sophie-Marie Tschmelitsch
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Andrea Schmidt
- Competence Center Climate and Health, Austrian National Public Health Institute (GOEG), Wien, Austria
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Katharina Brugger
- Competence Center Climate and Health, Austrian National Public Health Institute (GOEG), Wien, Austria
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Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
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Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT TIROL - University for Health Sciences and Technology, Hall in Tirol, Austria
| Published: | September 6, 2024 |
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Outline
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Introduction: In the context of climate change, the rate and severity of extreme heat periods (e.g., heat waves) is expected to increase in the coming years. For an effective health care system planning, it is crucial to prepare for the consequences extreme heat events will have for the health care system. Several studies have indicated that ambient outdoor temperature could affect mental health. However, the evidence-base displays considerable heterogeneity and methodological limitations (e.g., not adequately controlling for potentially relevant confounding factors such as non-temperature related seasonal trends).
Methods: We conducted a systematic review assessing the effect of exposure to extreme heat periods on health care utilization for mental health disorders, compared to a control population or counterfactual scenario without this exposure. We searched the databases Embase, Medline, and PsychINFO up to April 2024. Furthermore, we conducted reference searches in systematic reviews conducted on similar topics identified through the database searches. Eligible articles were quantitative epidemiological, observational studies in humans of all ages that evaluated real-world data on hospitalizations and other health care usage indicators. Risk of Bias was assessed using the appropriate CASP (Critical Appraisal Skills Programme) Checklists. As heterogeneity did not allow for a synthesis using meta-analysis, we summarized study findings narratively, focusing on direction of effect. The quality of evidence across studies will be assessed using the Office of Health Assessment and Translation (OHAT) approach.
Results: We identified 1,155 records through database searches, with 824 records included in title- and abstract screening. Out of six systematic reviews on similar topics, 155 additional unique records were identified. In the full-text screening of 83 records, we included 43 unique studies. Preliminary analysis found a pronounced heterogeneity in the studies, including their methodological approach, lag-periods under assessment, and reference temperature. We found a heterogenous but consistent increase in the rate of health care utilization for mental health disorders in general in the context of extreme heat exposure, in comparison to counterfactual periods without extreme heat exposure. Studies consistently reported an association between extreme heat exposure and hospitalization for organic psychiatric disorders including delirium and dementia as well as for schizophrenia. Studies showed inconsistent associations for mood disorders (e.g., depression and anxiety), with some studies showing a positive association, while others showed no effect or even a protective effect.
Conclusion: Extreme heat periods may increase the rate of health care utilization. However, this increase does not seem to affect all mental health disorders in the same way. Protective measures as well as health care preparedness for extreme heat periods should pay special attention to individuals affected by or at risk for organic psychiatric disorders as well as to people living with schizophrenia. More high-quality and causal research is required to improve our understanding of these effects, in particular focused on explaining the mixed effects found for the effect of extreme heat on mood disorders.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
