The impact of air pollution and climate change on mental health has recently raised strong concerns. However, a comprehensive overview analyzing the existing evidence while addressing relevant biases is lacking. This umbrella review systematically searched the PubMed/Medline, Scopus and PsycINFO databases (up to June 26, 2023) for any systematic review with meta‐analysis investigating the association of air pollution or climate change with mental health outcomes. We used the R metaumbrella package to calculate and stratify the credibility of the evidence according to criteria (i.e., convincing, highly suggestive, suggestive, or weak) that address several biases, complemented by sensitivity analyses. We included 32 systematic reviews with meta‐analysis that examined 284 individual studies and 237 associations of exposures to air pollution or climate change hazards and mental health outcomes. Most associations (n=195, 82.3%) involved air pollution, while the rest (n=42, 17.7%) regarded climate change hazards (mostly focusing on temperature: n=35, 14.8%). Mental health outcomes in most associations (n=185, 78.1%) involved mental disorders, followed by suicidal behavior (n=29, 12.4%), access to mental health care services (n=9, 3.7%), mental disorders‐related symptomatology (n=8, 3.3%), and multiple categories together (n=6, 2.5%). Twelve associations (5.0%) achieved convincing (class I) or highly suggestive (class II) evidence. Regarding exposures to air pollution, there was convincing (class I) evidence for the association between long‐term exposure to solvents and a higher incidence of dementia or cognitive impairment (odds ratio, OR=1.139), and highly suggestive (class II) evidence for the association between long‐term exposure to some pollutants and higher risk for cognitive disorders (higher incidence of dementia with high vs. low levels of carbon monoxide, CO: OR=1.587; higher incidence of vascular dementia per 1 μg/m3 increase of nitrogen oxides, NOx: hazard ratio, HR=1.004). There was also highly suggestive (class II) evidence for the association between exposure to airborne particulate matter with diameter ≤10 μm (PM10) during the second trimester of pregnancy and the incidence of post‐partum depression (OR=1.023 per 1 μg/m3 increase); and for the association between short‐term exposure to sulfur dioxide (SO2) and schizophrenia relapse (risk ratio, RR=1.005 and 1.004 per 1 μg/m3 increase, respectively 5 and 7 days after exposure). Regarding climate change hazards, there was highly suggestive (class II) evidence for the association between short‐term exposure to increased temperature and suicide‐ or mental disorders‐related mortality (RR=1.024), suicidal behavior (RR=1.012), and hospital access (i.e., hospitalization or emergency department visits) due to suicidal behavior or mental disorders (RR=1.011) or mental disorders only (RR=1.009) (RR values per 1°C increase). There was also highly suggestive (class II) evidence for the association between short‐term exposure to increased apparent temperature (i.e., the temperature equivalent perceived by humans) and suicidal behavior (RR=1.01 per 1°C increase). Finally, there was highly suggestive (class II) evidence for the association between the temporal proximity of cyclone exposure and severity of symptoms of post‐traumatic stress disorder (r=0.275). Although most of the above associations were small in magnitude, they extend to the entire world population, and are therefore likely to have a substantial impact. This umbrella review classifies and quantifies for the first time the global negative impacts that air pollution and climate change can exert on mental health, identifying evidence‐based targets that can inform future research and population health actions.

中文翻译：

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空气污染和气候变化对心理健康结果的影响：全球证据的总体审查


空气污染和气候变化对心理健康的影响最近引起了人们的强烈关注。然而，缺乏对现有证据进行分析并解决相关偏见的全面概述。该总体综述系统地检索了 PubMed/Medline、Scopus 和 PsycINFO 数据库（截至 2023 年 6 月 26 日），以查找任何通过荟萃分析调查空气污染或气候变化与心理健康结果之间关系的系统综述。我们使用 R metaumbrella 包根据解决多种偏差的标准（即令人信服、高度暗示、暗示或弱）来计算和分层证据的可信度，并辅以敏感性分析。我们纳入了 32 项系统评价和荟萃分析，检查了 284 项单独研究以及 237 项暴露于空气污染或气候变化危害与心理健康结果之间的关联。大多数协会（n=195，82.3%）涉及空气污染，而其余协会（n=42，17.7%）则关注气候变化危害（主要关注温度：n=35，14.8%）。大多数协会的心理健康结果（n = 185，78.1％）涉及精神障碍，其次是自杀行为（n = 29，12.4％），获得精神卫生保健服务（n = 9，3.7％），精神障碍相关症状学（n=8，3.3%），以及多个类别（n=6，2.5%）。 12 个协会 (5.0%) 获得了令人信服的（I 类）或高度暗示性的（II 类）证据。关于空气污染暴露，有令人信服的（I 类）证据表明长期接触溶剂与痴呆或认知障碍发病率较高之间存在关联（比值比，OR=1.139），以及长期接触某些污染物与认知障碍风险较高之间存在关联的高度提示性（II 类）证据（高水平与低水平一氧化碳、CO 相比，痴呆发生率更高：OR=1.587；更高每1μg/m2血管性痴呆发生率3氮氧化物（NO）增加x ：风险比，HR=1.004）。还有高度暗示性（II 类）证据表明暴露于直径≤10 μm 的空气颗粒物（PM 10 ）在妊娠中期与产后抑郁症的发生率（OR=1.023/1 μg/m 3增加）;以及短期暴露于二氧化硫 (SO 2 ）和精神分裂症复发（风险比，RR=1.005 和 1.004 每 1 μg/m 3分别在暴露后 5 天和 7 天增加）。关于气候变化危害，有高度提示性（II 类）证据表明短期暴露于升高的温度与自杀或精神障碍相关的死亡率（RR=1.024）、自杀行为（RR=1.012）和医院之间存在关联。由于自杀行为或精神​​障碍 (RR=1.011) 或仅精神障碍 (RR=1.009)（RR 值每升高 1°C）而进入（即住院或急诊科就诊）。还有高度暗示性（II 类）证据表明，短期暴露于升高的表观温度（即人类感知的等效温度）与自杀行为之间存在关联（每升高 1°C，RR=1.01）。 最后，有高度提示性（II 类）证据表明旋风暴露的时间接近性与创伤后应激障碍症状的严重程度之间存在关联（r=0.275）。尽管上述大多数关联的规模较小，但它们涉及到整个世界人口，因此可能产生重大影响。这项总体审查首次对空气污染和气候变化可能对心理健康产生的全球负面影响进行了分类和量化，确定了可以为未来研究和人口健康行动提供信息的循证目标。