Climate change refers to long-term changes in weather patterns and temperatures. Human activities have been the main cause of climate change since the 1800s, mainly due to the combustion of fossil fuels such as coal, oil and gas. 1 On the basis of its causes and consequences, climate change can be classified into various categories. The two main categories of climate change are man-made climate changes caused by greenhouse gas emissions and industrial activity, Reference Abbass, Qasim, Song, Murshed, Mahmood and Younis2 and natural changes driven by long-term processes such as solar variability and volcanic activity. Reference Shaw, Arias, Collins, Coumou, Diedhiou and Garfinkel3 Man-made changes tend to occur more rapidly, often within decades, whereas natural processes usually unfold over centuries or longer. Reference Shaw, Arias, Collins, Coumou, Diedhiou and Garfinkel3 In addition, certain localised forces such as urbanisation or land-use change can create region-specific climate effects, 4 but these are not considered a separate category. The World Health Organization (WHO) estimates that 3.6 billion people currently live in regions that are particularly vulnerable to climate change and estimates that approximately 250 000 additional deaths per year will be the result of climate change between 2030 and 2050. 4 An increased level of psychological, mental or physical distress in response to hazardous changes in the climate system is known as climate anxiety. Symptoms of climate anxiety include vulnerability, irritability, panic attacks, appetite loss and insomnia. Reference Dodds5 Eco-anxiety refers to a chronic fear of environmental doom that can range from mild worry to severe psychological distress, including symptoms such as anxiety, depression, post-traumatic stress disorder (PTSD) and suicidal thoughts.Reference Pihkala7 At-risk groups, such as children, elderly people, people with mental illness, people with mobility disabilities and those who are chronically ill, must be considered when assessing the effects of climate anxiety. Reference Ursano, Morganstein and Cooper8 Moreover, climate change has a disproportionate impact on people in lower socioeconomic categories, because of differences in infrastructure and health resources. Reference Dodds5 Furthermore, research has revealed that the prevalence of PTSD is 26% and depression is 21.7% in populations affected by catastrophic weather events such as hurricanes and floods. Reference Kip, Valencia, Glunz, Lowe, Tam and Morina9 According to a population-based study in Taiwan, for every 1°C increase in temperature, there is a 7% increase in major depressive disorder diagnoses, particularly among older people. Reference Chen, Lin and Guo10
Climate change in Iraq
Iraq is a country located in the Middle East, and the Kurdistan Region of Iraq (KRI) is an autonomous region in northern Iraq. The Kurdistan Region consists of four governorates: Erbil, Sulaymaniyah, Duhok and Halabja. It is a constitutionally recognised area with self-governing authority. 11 Iraq is a country vulnerable to climate-related stressors: it is the fifth most vulnerable to climate change globally, with extreme temperatures, recurring droughts and increasing desertification accelerating its path towards uninhabitability in the coming decades. Reference Ahmed12 The country’s average temperature has increased by 0.5°C per decade since the 1970s, and summer temperatures regularly exceed 50°C. 13 Climate variations across the country are influenced by latitude and high mountain ranges in the north. The northern mountainous regions receive higher rainfall (400–1000 mm per year) and colder temperatures, with snowfall in some areas during winter. In contrast, southern Iraq has a warm desert climate with significantly lower rainfall. 13
In a study conducted in camps for internally displaced people in Ninewa and Duhok, 74% of respondents reported a direct impact of climate change on their daily lives, with extreme heat leading to increased aggression, anxiety and sleep disturbances. Reference Marzouk, Duman, Meier, Khudhur and Alani14 In the Kurdistan Region, research highlights that 19% of residents experience severe eco-anxiety, with urban populations showing higher levels of distress due to worsening environmental conditions. Reference Mohammed, Ahmed, Qadr, Blbas, Ali and Saber15
The current study
The aim of this study is to examine the prevalence and impact of climate anxiety in Iraq, including the Kurdistan Region. It also seeks to analyse how demographic factors such as age, gender and geographical location influence climate anxiety levels. In addition, the study explores the relationship between climate anxiety and mental health, focusing on depression and generalised anxiety disorder, providing insight into its broader psychological effects.
Method
Study design and procedure
We used a cross-sectional study design that followed Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Reference von Elm, Altman, Egger, Pocock, Gøtzsche and Vandenbroucke16 To ensure the quality of the web-based survey, we also followed the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Reference Eysenbach17 A convenience sampling technique was used to collect data. The online survey was distributed through social media platforms, including Facebook, LinkedIn, Instagram and WhatsApp. Before beginning the survey, general instructions including research information were provided, and an informed consent form was included in the first section of the questionnaire. Data collection was carried out between 23 January and 15 February 2025.
Participants
A total of 1019 valid responses were received across 18 provinces. The inclusion criteria for participation in the study were: (a) being of Iraqi nationality, (b) residing within the geographical boundaries of Iraq at the time of data collection and (c) being 18 years of age or older. The exclusion criteria included (a) individuals under 18 years of age, (b) non-Iraqi nationals residing in Iraq and (c) Iraqi citizens living abroad.
Measures
The first part of the questionnaires assessed the sociodemographic characteristics of the participants, including gender (male/female), age, occupation (student/private sector worker/government employee/retired/unemployed), marital status (single/married/divorced/widowed/), economic status (very poor/poor/middle income/rich), health status, in answer to the question ‘How do you describe your health in general?’ with options (very good/good/bad/very bad), and educational level (elementary/secondary/university).
In the second part of the questionnaire, participants completed three measures: a validated Arabic version of the Climate Change Anxiety Scale (CCAS), Reference Fekih-Romdhane, Malaeb, Yakın, Sakr, Dabbous and El Khatib18 together with the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 questionnaire (GAD-7); the PHQ-9 and GAD-7 had been translated into Kurdish and Arabic and then back-translated into English by bilingual professionals to ensure accuracy.
Climate Change Anxiety Scale (CCAS)
The CCAS is a 13-item questionnaire designed to measure the degree of climate-related anxiety among individuals. Developed by Clayton & Karazsia (2020), Reference Clayton and Karazsia19 it consists of two subscales: the cognitive impairment subscale (eight items; for example ‘Thinking about climate change makes it difficult for me to sleep’) and the functional impairment subscale (five items; for example ‘I have problems balancing my concerns about sustainability with the needs of my family’). Respondents evaluate how often the CCAS statements applied to them using a 5-point Likert scale, ranging from 1 (‘never’) to 5 (‘almost always’). The cut-off scores are as follows: scores <21 indicate no or minimal climate anxiety, scores between 21 and 22 indicate mild to moderate climate anxiety, and scores ≥23 indicate severe to extremely severe climate anxiety. Reference Cosh, Williams, Lykins, Bartik and Tully20 The scale demonstrated good reliability (Cronbach’s α = 0.89).
Patient Health Questionnaire-9 (PHQ-9)
The PHQ-9 is a 9-item self-report measure that evaluates the severity of depressive symptoms over the previous 2 weeks. Reference Kroenke, Spitzer and Williams21 An example item includes ‘Thoughts that you would be better off dead or hurting yourself’. Responses are rated on a 4-point scale, from 0 (‘not at all’) to 3 (‘nearly every day’). Total scores range from 0 to 27, with 15–19 indicating moderately severe depression and ≥20 indicating severe depression. In this study, the PHQ-9 demonstrated good reliability (Cronbach’s α = 0.88).
Generalised Anxiety Disorder-7 (GAD-7)
The GAD-7 is a 7-item self-report tool designed to evaluate general anxiety levels. Reference Spitzer, Kroenke, Williams and Löwe22 Each item is scored on a 4-point scale, ranging from 0 (‘not at all’) to 3 (‘nearly every day’), with total scores ranging from 0 to 21. A score ≥15 indicates severe generalised anxiety disorder. The GAD-7 demonstrated excellent reliability (Cronbach’s α = 0.91).
Statistical analysis
The Statistical Package for the Social Sciences (SPSS) version 27.0 for Windows (IBM Corp., Armonk, NY, USA; see https://www.ibm.com/products/spss-statistics) was used for statistical analysis. Jupyter Notebook version 6.5.4, 2023 for Windows (Project Jupyter, open-source, see https://jupyter.org/) was used to generate regression graphs. ArcGIS Desktop Version 10.8 for Windows (Esri, Redlands, CA, USA; see https://www.esri.com/) was used to visualise the regional distribution of climate anxiety on a map. Cronbach’s α was calculated to assess the internal consistency of the study instruments. Descriptive statistics were used to analyse the participants’ sociodemographic characteristics and to determine the overall prevalence of climate anxiety. Independent-sample t-tests were performed to assess gender and age differences in CCAS scores, and one-way analysis of variance (ANOVA) was used to examine regional variations across different provinces. To estimate the impact of climate anxiety, we assessed its association with two key mental health outcomes: depression (PHQ-9) and generalised anxiety disorder (GAD-7). Pearson’s correlation analyses were performed to determine the associations between climate anxiety and mental health outcomes. Additionally, simple linear regression models were used to examine the predictive effect of climate anxiety on both depression and general anxiety levels. The strength of these models, represented by beta coefficients and R 2-values, provided a quantitative estimate of the psychological impact of climate anxiety on the study population.
Results
Participants
Table 1 shows sociodemographic characteristics of the participants. In total, 1019 participants were included in the study, with a slight majority being women (women: n = 532, 52.2%; men: n = 487, 47.8%). The mean age was 31.91 years (s.d. = 10.01, range 18–72 years) and the age was classified into two groups: young adults (18–41 years) and older adults (42–71 years). Most participants were in employment (58.4%) and classified themselves as middle income (88.8%). Just over half (50.5%) were married. Most reported good health (63.6%) and 92.0% had obtained higher education. The majority of the sample (75.6%) lived in the north of the country, in the Kurdistan Region of Iraq (KRI).
Demographic characteristics of the participants (n = 1019)
Prevalence and regional distribution of climate anxiety
The impact of climate change was observed across Iraq, and most (71.4%) participants reported severe levels of climate anxiety; only 21.8% reported minimal or no climate anxiety (Table 2). By region, more participants reported severe climate anxiety in the north (KRI, 73.2%) than in the central and southern provinces (65.9%). To explore the significance of climate anxiety in individual provinces in Iraq, we performed a sub-analysis in which provinces with a small sample size and no significant results on climate anxiety were removed. The results indicated that five provinces exhibited significantly higher levels of climate anxiety compared with others: Ninawa (mean 34.44, s.d. = 7.9), Basrah (mean 32.54, s.d. = 12.2), Najaf (mean 30.82, s.d. = 10.89), Duhok (mean 30.42, s.d. = 10.12) and Erbil (mean 30.22, s.d. = 9.58). One-way ANOVA identified significant differences in climate anxiety levels between some provinces (F(17,1001) = 2.92, P = 0.001, η 2 = 0.04). Figure 1 presents a map highlighting individual provinces with highest levels of climate anxiety.
Prevalence of climate anxiety
Iraqi provinces where participants experienced the highest levels of climate anxiety. KRI, Kurdistan Region of Iraq.
Gender and age differences in climate anxiety
An independent-sample t-test revealed no significant differences in climate anxiety between males and females (Table 3). However, older adults (42–72 years) reported significantly higher climate anxiety than younger adults (18–41 years) (Cohen’s d = 0.22, indicating a small effect size).
Gender and age differences in climate anxiety
Correlation and regression between climate anxiety and mental health (depression and generalised anxiety disorder)
A Pearson correlation analysis (Table 4) revealed a positive correlation between climate anxiety and depression and generalised anxiety disorder, indicating that higher climate anxiety was associated with increased symptoms of depression and anxiety.
Correlation between climate anxiety, depression and generalised anxiety
PHQ-9, Patient Health Questionnaire-9; GAD-7, Generalised Anxiety Disorder-7 questionnaire.
**The correlation is significant at the 0.01 level (2-tailed).
Furthermore, simple linear regression was significant (β = 0.25, t = 13.19, P < 0.001, 95% CI 0.219–0.206); the regression equation F(1,1017) = 174.3, P < 0.01, with R 2 = 0.146, indicated that climate anxiety represented 14.6% of the variance in depression, and the result was significant (β = 0.214, t = 12.32, P < 0.01, 95% CI 0.18– 0.248; the regression F(1,1017) = 151.99, P < 0.01, with R 2 = 0.13, indicated that climate anxiety accounted for 13% of the variance in generalised anxiety disorder. The regression results are shown in Fig. 2.
Regression model for climate anxiety, depression and generalised anxiety disorder.
Discussion
The current study aimed to assess the prevalence and impact of climate anxiety and its association with mental health problems in Iraq. The findings revealed a substantial burden, with 71.4% of participants reporting severe levels of climate anxiety. In particular, severe climate anxiety was more prevalent in the Kurdistan Region (73.2%) compared with the central and southern Iraqi provinces (65.9%), and in the individual provinces of Ninawa, Basrah, Najaf, Duhok and Erbil.
Globally, studies have shown widespread anxiety related to climate change. Approximately 59% of people reported feeling very or extremely concerned, while 84% expressed at least moderate concern. Many also reported experiencing negative emotions such as sadness, anxiety, anger, powerlessness, helplessness, and guilt, which were associated with poorer mental well-being. Reference Hickman, Marks, Pihkala, Clayton, Lewandowski and Mayall23–Reference Abbasi25 Our study identified notable sociodemographic variations in climate anxiety. Age appeared to be a significant factor, with older adults reporting higher levels of climate anxiety than younger participants. This finding is consistent with other research that indicated that older individuals are more susceptible to climate anxiety, possibly because of their prolonged exposure to environmental changes and greater awareness of long-term consequences. Reference Gezgin Yazıcı, Ökten and Utaş Akhan26 On the contrary, the gender differences in climate anxiety in our study were not statistically significant, suggesting that men and women in Iraq experience similar levels of climate anxiety. However, this finding differs from research conducted among French-speaking people in eight European and African countries, where women were found to have significantly higher levels of climate anxiety than men. Reference Heeren, Mouguiama-Daouda and Contreras27 These variations suggest that sociocultural and environmental factors may influence the extent to which different demographic groups experience climate-related distress.
Regarding the association between climate anxiety and mental health problems, our study found a positive correlation in which higher levels of climate anxiety were significantly associated with increased depression and generalised anxiety disorder. Furthermore, while the regression analyses demonstrated a significant association between climate anxiety and both depression and generalised anxiety disorder, it is important to note that climate anxiety accounted for only 14.6% and 13% of the variance in depression and anxiety, respectively. This suggests that although climate anxiety contributes meaningfully to these mental health outcomes, it explains only a modest portion of the variance. Other unmeasured psychosocial, environmental or individual-level factors are likely to contribute substantially to symptoms of depression and generalised anxiety. These findings should caution readers against overestimating the clinical importance of climate anxiety in isolation and underscore the need for multifactorial models. Nevertheless, our results are consistent with global research indicating that climate anxiety is positively correlated with depression and anxiety disorders, particularly among vulnerable populations with limited access to mental health support, such as older adults and rural residents. Reference Abbasi25,Reference Cosh, Ryan, Fallander, Robinson, Tognela and Tully28–Reference White, Breakey, Brown, Smith, Tarbet and Nicholas30
Recommendations and implications
Given Iraq’s ranking as one of the countries most vulnerable to climate change, the findings of this study emphasise that climate change should be recognised not only as an environmental crisis, but also as a pressing mental health challenge. It is essential that Iraq integrates mental health and psychosocial support (MHPSS) components into its national climate adaptation and disaster risk reduction strategies. The results demonstrate the need for targeted MHPSS interventions, particularly for older adults, individuals with pre-existing mental health conditions, and populations living in regions most severely affected by climate anxiety and environmental degradation. Future research should investigate the long-term psychological impacts of climate-related events, identify protective factors and assess the effectiveness of various psychosocial and community resilience-building strategies. Longitudinal and interdisciplinary studies are needed to explore how different demographic groups, such as youth, women and internally displaced persons, experience and respond to climate-related stressors. Furthermore, research should examine how factors such as social support, religious coping and traditional ecological knowledge influence mental health outcomes in the face of climate change.
Without proactive and coordinated action, the mental health consequences of climate change are likely to intensify, placing even greater strain on Iraq’s already fragile healthcare and social support systems. Addressing this emerging crisis requires collaboration between environmental policymakers, health professionals, humanitarian actors and researchers to ensure holistic, sustainable and inclusive responses.
Strengths and limitations of the study
This study is among the first empirical investigations to explore climate anxiety and its mental health impacts across Iraq. However, several limitations should be disclosed. First, the use of a cross-sectional design prevents us from establishing causal relationships between climate anxiety and mental health outcomes. Second, the study relied on self-reported measures, which are subject to social desirability bias and potential recall inaccuracies. Furthermore, the sample was obtained through online recruitment; people in rural areas may be more affected by climate change; however, owing to illiteracy and limited knowledge of online platforms, their participation in the survey might be lacking. Furthermore, the overrepresentation of participants from the Kurdistan Region may have influenced the observed prevalence rates and regional comparisons. Future research should aim for a more balanced regional distribution and incorporate mixed-method approaches, including qualitative assessments, to gain a deeper understanding of the psychological burden of climate anxiety in Iraq.
Acknowledgements
We thank everyone who helped complete the survey and circulated it in the community, especially Insight Clinic.
Author contributions
D.R.A. contributed to generating ideas, study design, contextualization, data interpretation and analysis, and writing and revising the manuscript. K.K.K. contributed to data analysis and data collection. R.H.A.-T. contributed to writing part of the manuscript and data collection. J.O.A. participated in data collection. R.H. provided crucial feedback and comments.
Funding
This research received no specific grant from any funding agency, commercial or not-for-profit sectors.
Declaration of interest
None.
Ethical considerations
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2013, and ethical approval was obtained from the scientific and human subjects committee of the Psychology Department at Soran University (Approval: No. 22D).
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