Exploratory empirical model of combined effects of covid-19 and climate change on youth mental health

ABSTRACT The COVID-19 pandemic and climate change have been linked to increasing mental health vulnerability globally, with particular concern for heavily impacted regions such as the

Caribbean and susceptible groups such as youth. Here we provide an exploratory empirical model of COVID-19 and climate change effects on anxiety levels in youth in three countries of the

Caribbean Community. From September 2021 to April 2022, an anonymous cross-sectional survey was distributed online to youths (ages 18–24) in Barbados, Trinidad and Tobago, and Guyana via

Facebook advertisements, social media influencers and youth ambassadors. Among a broader survey of health and well-being factors, we measured climate distress/COVID-19 distress, the extent

to which thoughts of climate change or the pandemic interfered with their mental health, and generalized anxiety. Using robust bootstrapped mediation models, we investigated the relationship

between mental health interference and anxiety, as mediated by distress levels regarding both crises. In a sample of _N_ = 476 youth, we explored three models based on the survey data.

First, we established a relationship between climate distress and anxiety levels. Second, COVID-19 mental health interference’s association with anxiety was mediated by COVID-19 distress

(0.14 × 0.32 = 0.04, 95% CI: 0.03–0.06, _P_ _=_ 0.001), explaining 29% of the variance. Last, a cross-cutting relationship was observed between COVID-19 and climate change-related mental

health, with climate distress mediating relationships between COVID-19 interference and anxiety (0.08 × 0.25 = 0.02, 95% CI: 0.01–0.03, _P_ _=_ 0.001) and the model explaining 28% of the

variance. This study supports models that the perceived interference of the pandemic on well-being is associated with generalized anxiety levels and partially explained by specific

pandemic-related distress levels. It also provides evidence that climate distress is associated with generalized anxiety. This work leads toward an understanding of pathways to decreased

well-being among youth and areas for intervention (for example, coping with distress). This study is among the first to link the climate and COVID-19 crises with empirical data, looking at

these as crises rather than specific events. We provide a clear construct of the pathway from crisis to decreased mental wellness that could inform future intervention studies. While our

analyses were robust and findings add novelty to the literature, future work is needed to confirm and elucidate the temporality of the associations measured with longitudinal data. Access

through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to this journal

Receive 12 digital issues and online access to articles $79.00 per year only $6.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy

now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer

support SIMILAR CONTENT BEING VIEWED BY OTHERS CLIMATE-RELATED EXPERIENCES AND HARMS IN THE WAKE OF THE COVID-19 PANDEMIC: RESULTS FROM A SURVEY OF 152,088 MEXICAN YOUTH Article Open access

02 October 2023 INTRODUCTION AND BEHAVIORAL VALIDATION OF THE CLIMATE CHANGE DISTRESS AND IMPAIRMENT SCALE Article Open access 12 July 2023 A DUAL-CONTINUUM FRAMEWORK TO EVALUATE CLIMATE

CHANGE IMPACTS ON MENTAL HEALTH Article 31 October 2024 DATA AVAILABILITY Data are available via reasonable request to the corresponding author. REFERENCES * Pulwarty, R. S., Nurse, L. A.

& Trotz, U. O. Caribbean islands in a changing climate. _Environ. Sci. Policy Sustain. Dev._ 52, 16–27 (2010). Google Scholar  * Thomas, A. & Benjamin, L. Non-economic loss and

damage: lessons from displacement in the Caribbean. _Clim. Policy_ 20, 715–728 (2020). Google Scholar  * _Health and Climate Change: Country Profile 2020: Trinidad and Tobago_ (World Health

Organization & United Nations Framework Convention on Climate Change, 2020); https://iris.who.int/handle/10665/336269 * Zuñiga, R. A. A., Lima, G. N. & Villoria, A. M. G. Impact of

slow-onset events related to climate change on food security in Latin America and the Caribbean. _Curr. Opin. Environ. Sustain._ 50, 215–224 (2021). Google Scholar  * Chen, J., Zhang, S. X.,

Yin, A. & Yáñez, J. A. Mental health symptoms during the COVID-19 pandemic in developing countries: a systematic review and meta-analysis. _J. Glob. Health_ 12, 05011 (2022). PubMed 

PubMed Central  Google Scholar  * Murphy, M. M. et al. COVID-19 containment in the Caribbean: the experience of small island developing states. _Res. Glob._

https://doi.org/10.1016/j.resglo.2020.100019 (2020). * Sugg, M. M., Runkle, J. D., Hajnos, S. N., Green, S. & Michael, K. D. Understanding the concurrent risk of mental health and

dangerous wildfire events in the COVID-19 pandemic. _Sci. Total Environ._ 806, 150391 (2022). CAS  PubMed  ADS  Google Scholar  * _State of the Climate in Latin America and the Caribbean

2020_ (World Meteorological Organization, 2021); https://library.wmo.int/index.php?lvl=notice_display&id=21926#.YtXRK0XMJPZ * Marazziti, D. et al. Climate change, environment pollution,

COVID-19 pandemic and mental health. _Sci. Total Environ._ 773, 145182 (2021). CAS  PubMed  PubMed Central  ADS  Google Scholar  * Zang, S. M., Benjenk, I., Breakey, S., Pusey-Reid, E. &

Nicholas, P. K. The intersection of climate change with the era of COVID-19. _Public Health Nurs._ 38, 321–335 (2021). PubMed  PubMed Central  Google Scholar  * Kulcar, V., Siller, H. &

Juen, B. Discovering emotional patterns for climate change and for the COVID-19 pandemic in university students. _J. Clim. Change Health_ 6, 100125 (2022). Google Scholar  * Lawrance, E. L.

et al. Psychological responses, mental health, and sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study.

_Lancet Planet. Health_ 6, e726–e738 (2022). PubMed  PubMed Central  Google Scholar  * Pilgrim, N. A. & Blum, R. W. Adolescent mental and physical health in the English-speaking

Caribbean. _Rev. Panam. Salud Publica_ 32, 62–69 (2012). PubMed  Google Scholar  * Charlson, F. et al. Global priorities for climate change and mental health research. _Environ. Int._ 158,

106984 (2022). PubMed  Google Scholar  * Arvidsdotter, T., Marklund, B., Kylén, S., Taft, C. & Ekman, I. Understanding persons with psychological distress in primary health care. _Scand.

J. Caring Sci._ 30, 687–694 (2016). PubMed  Google Scholar  * Yan, L., Gan, Y., Ding, X., Wu, J. & Duan, H. The relationship between perceived stress and emotional distress during the

COVID-19 outbreak: effects of boredom proneness and coping style. _J. Anxiety Disord._ 77, 102328 (2021). PubMed  Google Scholar  * Alimoradi, Z., Ohayon, M. M., Griffiths, M. D., Lin, C. Y.

& Pakpour, A. H. Fear of COVID-19 and its association with mental health-related factors: systematic review and meta-analysis. _BJPsych Open_ 8, e73 (2022). PubMed  Google Scholar  *

Keough, M. E., Riccardi, C. J., Timpano, K. R., Mitchell, M. A. & Schmidt, N. B. Anxiety symptomatology: the association with distress tolerance and anxiety sensitivity. _Behav. Ther._

41, 567–574 (2010). PubMed  PubMed Central  Google Scholar  * Vujanovic, A. A. & Zegel, M. in _Emotion in Posttraumatic Stress Disorder: Etiology, Assessment, Neurobiology, and

Treatment_ (eds Tull, M. T. & Kimbrel, N. A.) 343–376 (Elsevier, 2020); https://doi.org/10.1016/B978-0-12-816022-0.00012-0 * _The Impact of COVID-19 on the Mental Health of Adolescents

and Youth_ (UNICEF, 2020); https://www.unicef.org/lac/en/impact-covid-19-mental-health-adolescents-and-youth * Wang, Y., Kala, M. P. & Jafar, T. H. Factors associated with psychological

distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: a systematic review and meta-analysis. _PLoS ONE_ 15, e0244630 (2020). CAS  PubMed 

PubMed Central  Google Scholar  * van Nieuwenhuizen, A., Hudson, K., Chen, X. & Hwong, A. R. The effects of climate change on child and adolescent mental health: clinical considerations.

_Curr. Psychiatry Rep._ 23, 88 (2021). PubMed  Google Scholar  * Arora, P. G. & Persaud, S. Suicide among Guyanese youth: barriers to mental health help-seeking and recommendations for

suicide prevention. _Int. J. Sch. Educ. Psychol._ 8, 133–145 (2019). Google Scholar  * Brown, C. R. et al. Social determinants of depression and suicidal behaviour in the Caribbean: a

systematic review. _BMC Public Health_ 17, 577 (2017). PubMed  PubMed Central  Google Scholar  * Liverpool, S., Pereira, B., Pollard, M., Prescod, J. & Trotman, C. Children and young

people’s mental health in the English-speaking Caribbean: a scoping review and evidence map. _Child Adolesc. Psychiatry Ment. Health_ 15, 82 (2021). PubMed  PubMed Central  Google Scholar  *

Kelman, I. et al. A review of mental health and wellbeing under climate change in small island developing states (SIDS). _Environ. Res. Lett._ 16, 033007 (2021). PubMed  PubMed Central  ADS

  Google Scholar  * Britton, J. C., Lissek, S., Grillon, C., Norcross, M. A. & Pine, D. S. Development of anxiety: the role of threat appraisal and fear learning. _Depress. Anxiety_ 28,

5–17 (2011). PubMed  Google Scholar  * Freeston, M., Tiplady, A., Mawn, L., Bottesi, G. & Thwaites, S. Towards a model of uncertainty distress in the context of Coronavirus (COVID-19).

_Cogn. Behav. Ther._ 13, e31 (2020). Google Scholar  * Zinbarg, R. E., Williams, A. L. & Mineka, S. A current learning theory approach to the etiology and course of anxiety and related

disorders. _Annu. Rev. Clin. Psychol._ 18, 233–258 (2022). PubMed  Google Scholar  * Silver, R. C., Holman, E. A. & Garfin, D. R. Coping with cascading collective traumas in the United

States. _Nat. Human Behav._ 5, 4–6 (2021). Google Scholar  * Pazderka, H. et al. Collective trauma and mental health in adolescents: a retrospective cohort study of the effects of

retraumatization. _Front. Psychiatry_ https://doi.org/10.3389/fpsyt.2021.682041 (2021). * Zhai, P., Zhou, B. & Chen, Y. A review of climate change attribution studies. _J. Meteorol.

Res._ 32, 671–692 (2018). Google Scholar  * Chattu, V. K. & Chami, G. Global health diplomacy amid the COVID-19 pandemic: a strategic opportunity for improving health, peace, and

well-being in the CARICOM Region—a systematic review. _Soc. Sci._ 9, 88 (2020). Google Scholar  * Daly, M. & Robinson, E. Psychological distress and adaptation to the COVID-19 crisis in

the United States. _J. Psychiatric Res._ 136, 603–609 (2021). Google Scholar  * Evans, G. W. Projected behavioral impacts of global climate change. _Annu. Rev. Psychol._ 70, 449–474 (2019).

PubMed  Google Scholar  * Searle, K. & Gow, K. Do concerns about climate change lead to distress? _Int. J. Clim. Change Strat. Manag._ 24, 362–379 (2010). Google Scholar  * Bradley, G.

L., Reser, J. P., Glendon, A. I. & Ellul, M. C. in _Stress and Anxiety: Applications to Social And Environmental Threats, Psychological Well-Being, Occupational Challenges, and

Developmental Psychology_ (eds Kaniasty, K. et al.) 33–42 (Logos, 2014). * Clayton, S. Climate anxiety: psychological responses to climate change. _J. Anxiety Disord._ 74, 102263 (2020).

PubMed  Google Scholar  * Latkin, C., Dayton, L., Scherkoske, M., Countess, K. & Thrul, J. What predicts climate change activism?: An examination of how depressive symptoms, climate

change distress, and social norms are associated with climate change activism. _J. Clim. Change Health_ 8, 100146 (2022). * Lawrance, E. L. et al. Psychological responses, mental health, and

sense of agency for the dual challenges of climate change and the COVID-19 pandemic in young people in the UK: an online survey study. _Lancet Planet. Health_ 6, e726-38 (2022). Google

Scholar  * Albrecht, G. in _Climate Change and Human Well-Being_ (eds Weissbecker, I.) 43–56 (Springer, 2011). * Reser, J. P., Bradley, G. L., Glendon, A. I., Ellul, M. C. & Callaghan,

R. _Public Risk Perceptions, Understandings and Responses to Climate Change and Natural Disasters in Australia, 2010 and 2011_ (National Climate Change Adaptation Research Facility Gold

Coast, 2012). * Necho, M., Tsehay, M., Birkie, M., Biset, G. & Tadesse, E. Prevalence of anxiety, depression, and psychological distress among the general population during the COVID-19

pandemic: a systematic review and meta-analysis. _Int. J. Soc. Psychiatry_ 67, 892–906 (2021). PubMed  Google Scholar  * Holingue, C. et al. Mental distress in the United States at the

beginning of the COVID-19 pandemic. _Am. J. Public Health_ 110, 1628–1634 (2020). PubMed  PubMed Central  Google Scholar  * Zhang, J. et al. The differential psychological distress of

populations affected by the COVID-19 pandemic. _Brain Behav. Immun._ 87, 49–50 (2020). CAS  PubMed  PubMed Central  Google Scholar  * Duong, D. Reconciliation in health care must go beyond

cultural sensitivity. _Can. Med. Assoc. J._ 193, E256–E257 (2021). Google Scholar  * Lathabhavan, R. Fear of COVID-19, psychological distress, well-being and life satisfaction: a comparative

study on first and second waves of COVID-19 among college students in India. _Curr. Psychol._ https://doi.org/10.1007/s12144-022-03207-7 (2022). * Taylor, S. The psychology of pandemics:

lessons learned for the future. _Can. Psychol._ 63, 233–246 (2022). Google Scholar  * Tam, K.-P., Leung, A. K.-Y. & Clayton, S. Research on climate change in social psychology

publications: a systematic review. _Asian J. Soc. Psychol._ 24, 117–143 (2021). Google Scholar  * Ma, T., Moore, J. & Cleary, A. Climate change impacts on the mental health and wellbeing

of young people: a scoping review of risk and protective factors. _Soc. Sci. Med._ 301, 114888 (2022). PubMed  Google Scholar  * Doherty, T. J. & Clayton, S. The psychological impacts

of global climate change. _Am. Psychol._ 66, 265–276 (2011). PubMed  Google Scholar  * Spitzer, R. L., Kroenke, K., Williams, J. B. W. & Löwe, B. A brief measure for assessing

generalized anxiety disorder: the GAD-7. _Arch. Intern. Med._ 166, 1092–1097 (2006). PubMed  Google Scholar  * Ganadjian, T. T., Monteiro, M., Sanchez, Z. M. & Wagner, G. A. Impacts on

anxiety symptoms and alcohol consumption among people with disabilities and family caregivers in Latin America and the Caribbean during the first wave of the COVID-19 pandemic. _Public

Health_ https://doi.org/10.1016/j.puhe.2022.06.026 (2022). * Maharaj, R. et al. Somatoform disorders among patients attending walk-in clinics in Trinidad: prevalence and association with

depression and anxiety. _Ment. Health Fam. Med._ 10, 81–88 (2013). PubMed  PubMed Central  Google Scholar  * Rich, B. table1: Tables of Descriptive Statistics in HTML v.1.4.2 (2021);

https://CRAN.R-project.org/package=table1 * R Core Team _R: A Language and Environment for Statistical Computing_ (R Foundation for Statistical Computing, 2022); https://www.R-project.org/ *

van der Laken, P. _Create a Publication-Ready Correlation Matrix, with Significance Levels, in R_ (2020);

https://paulvanderlaken.com/2020/07/28/publication-ready-correlation-matrix-significance-r/ * MacKinnon, D. P., Fairchild, A. J. & Fritz, M. S. Mediation analysis. _Annu. Rev. Psychol._

58, 593–614 (2007). PubMed  PubMed Central  Google Scholar  * Tingley, D., Yamamoto, T., Hirose, K., Keele, L. & Imai, K. mediation: R package for causal mediation analysis. _J. Stat.

Softw_. https://doi.org/10.18637/jss.v059.i05 (2014). * Hebbali, A. olsrr: Tools for Building OLS Regression Models v.0.5.3 (2020); https://CRAN.R-project.org/package=olsrr * Zeileis, A.

& Hothorn, T. Diagnostic checking in regression relationships. _R News_ 2, 7–10 (2002). Google Scholar  * Alfons, A. robmed: (Robust) Mediation Analysis v.0.11.0 (2022);

https://CRAN.R-project.org/package=robmed * Todorov, V. & Filzmoser, P. An object-oriented framework for robust multivariate analysis. _J. Stat. Softw_.

https://doi.org/10.18637/jss.v032.i03 (2009). Download references ACKNOWLEDGEMENTS We thank each of the institutions and individuals who assisted with survey recruitment. We also thank

survey participants. Q.S. was funded by the Queen Elizabeth Scholars program. The study was funded by The University of the West Indies Grant Number Campus Research and Publication

Fund—CRP.3.MAR21.08. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Psychiatry, McGill University, Montreal, Quebec, Canada Quinta Seon & Ian Gold * School of Medicine,

Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados Natalie Greaves & Michael Campbell * George Alleyne Chronic Disease Research Centre, The University of

the West Indies, Cave Hill, Barbados Simon Anderson & Eden Augustus * Glasgow Caribbean Centre for Development Research, The University of the West Indies, Cave Hill, Barbados Simon

Anderson * Caribbean College of Family Physicians, Kingston, Jamaica Paula Henry * Faculty of Health Sciences, University of Guyana, Turkeyen Campus, Greater Georgetown, Guyana Emanuel

Cummings & Leann Kendall * Pan American Health Organization, Port of Spain, Trinidad and Tobago Erica Wheeler * School of Communication and Arts, The University of Queensland, Brisbane,

Queensland, Australia Ans Vercammen * Imperial College London, South Kensington Campus, London, UK Emma Lawrance * Faculty of Medical Sciences, The University of the West Indies, St

Augustine, Trinidad and Tobago Donald Simeon, Terence Seemungal & Sandeep B. Maharaj * Planetary Health Alliance, Boston, MA, USA Sandeep B. Maharaj Authors * Quinta Seon View author

publications You can also search for this author inPubMed Google Scholar * Natalie Greaves View author publications You can also search for this author inPubMed Google Scholar * Michael

Campbell View author publications You can also search for this author inPubMed Google Scholar * Simon Anderson View author publications You can also search for this author inPubMed Google

Scholar * Paula Henry View author publications You can also search for this author inPubMed Google Scholar * Eden Augustus View author publications You can also search for this author

inPubMed Google Scholar * Emanuel Cummings View author publications You can also search for this author inPubMed Google Scholar * Leann Kendall View author publications You can also search

for this author inPubMed Google Scholar * Erica Wheeler View author publications You can also search for this author inPubMed Google Scholar * Ans Vercammen View author publications You can

also search for this author inPubMed Google Scholar * Emma Lawrance View author publications You can also search for this author inPubMed Google Scholar * Donald Simeon View author

publications You can also search for this author inPubMed Google Scholar * Terence Seemungal View author publications You can also search for this author inPubMed Google Scholar * Ian Gold

View author publications You can also search for this author inPubMed Google Scholar * Sandeep B. Maharaj View author publications You can also search for this author inPubMed Google Scholar

CONTRIBUTIONS Q.S. is the primary author of the manuscript and was responsible for the conceptualization of theories and data analyses. S.B.M. is principal investigator for the study and

was involved in conceptualization, planning, data collection and data interpretation. I.G. assisted in conceptualizing the manuscript and theories and interpreting results. E.L. and A.V.

conceptualized and guided on project planning and analyses. E.A., N.G., M.C., E.W. and S.A. were the implementation and execution team in Barbados, including data collection and youth

ambassador recruitment. P.H. piloted questionnaires to contextualization with youth groups. D.S. and T.S. were the implementation team and execution team in Trinidad and Tobago and consulted

on data analyses. E.C. and L.K. were the implementation team and execution team in Guyana. CORRESPONDING AUTHOR Correspondence to Sandeep B. Maharaj. ETHICS DECLARATIONS COMPETING INTERESTS

The authors declare no competing interests. PEER REVIEW PEER REVIEW INFORMATION _Nature Mental Health_ thanks Shuquan Chen, Shaun Liverpool and Sarah EO Schwartz for their contribution to

the peer review of this work. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION Supplementary Note. REPORTING SUMMARY RIGHTS AND PERMISSIONS Springer Nature or its licensor (e.g. a society or other partner) holds

exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely

governed by the terms of such publishing agreement and applicable law. Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Seon, Q., Greaves, N., Campbell, M. _et al._ Exploratory

empirical model of combined effects of COVID-19 and climate change on youth mental health. _Nat. Mental Health_ 2, 218–227 (2024). https://doi.org/10.1038/s44220-023-00197-8 Download

citation * Received: 09 November 2022 * Accepted: 15 December 2023 * Published: 09 February 2024 * Issue Date: February 2024 * DOI: https://doi.org/10.1038/s44220-023-00197-8 SHARE THIS

ARTICLE Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard

Provided by the Springer Nature SharedIt content-sharing initiative