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Temperature-related deaths in people with psychosis, dementia and substance misuse

  • Lisa A. Page (a1), Shakoor Hajat (a2), R. Sari Kovats (a2) and Louise M. Howard (a3)



Climate change is expected to have significant effects on human health, partly through an increase in extreme events such as heatwaves. People with mental illness may be at particular risk.


To estimate risk conferred by high ambient temperature on patients with psychosis, dementia and substance misuse.


We applied time-series regression analysis to data from a nationally representative primary care cohort study. Relative risk of death per 1° increase in temperature was calculated above a threshold.


Patients with mental illness showed an overall increase in risk of death of 4.9% (95% CI 2.0–7.8) per 1° increase in temperature above the 93rd percentile of the annual temperature distribution. Younger patients and those with a primary diagnosis of substance misuse demonstrated greatest mortality risk.


The increased risk of death during hot weather in patients with psychosis, dementia and substance misuse has implications for public health strategies during heatwaves.

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Corresponding author

Dr Lisa Page, Mental Health Liaison Team, Royal Sussex County Hospital, Sussex Partnership NHS Foundation Trust. email:


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Declaration of interest

R.S.K. has received funding from the EuroHEAT initiative funded by the World Health Organization and European Union.



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Temperature-related deaths in people with psychosis, dementia and substance misuse

  • Lisa A. Page (a1), Shakoor Hajat (a2), R. Sari Kovats (a2) and Louise M. Howard (a3)


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Temperature-related deaths in people with psychosis, dementia and substance misuse

  • Lisa A. Page (a1), Shakoor Hajat (a2), R. Sari Kovats (a2) and Louise M. Howard (a3)
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Prepare Properly For Potential Heatwaves

Neil M. Gunn, Clinical Nurse
05 September 2012

In recent years, heat waves have been a particularly 'hot' topic for everyone in the realms of public health and now more than ever has the issue shone light on how we are managing the effects on community mental health. This interest has exponentially increased due to major documentation and research into more recent heat waves throughout Australia, North America and Europe (Kovats & Hajat, 2008). Unfortunately, with all the inroads that have been made into identifying those most at risk of heat-related mortality, little empirical research has been compiled into the effectiveness of public health interventions, to successfully decrease mortality during these times of extreme heat (Kovats, 2008).

In keeping with Page, Hajat, Kovats & Howards (2012) article, those who are deemed as being "high risk" in local and national heat wave preparedness plans are still not being protected by primary mental health care organisations, as they are not deemed to be under the direct care of these services. This example is amplified by those who have substance abuse issues during times of extreme heat - as they are traditionally lessopen to attending public health interventions and they are not usually in regular contact with health professionals, thus, increasing their chance of death during these events. Those with mental health issues have complexvulnerabilities and lack clarity in 'unusual' events, which leads to situations where those who are actually in need to "fall through the cracks" of the heath system. This is a failure of the health system and shows major issues with our preparation in the event of a heat wave (Holt et al., 2007; McCoy, Metsch, Chitwood, & Miles, 2001).

Many people in our society are vulnerable, as a result of the environments they live. It is pivotal that geographical data and demographical history or all areas is gathered, to helpo create a safe andeffective interplay between one's socio-demographics and the different biophysical environments in which individuals inhabit (Loughnan, Tapper, Phan, Lynch, & McInnes, 2012). Protection of more vulnerable communities needs to be a collaborative effort; public health professionals working in unison with mental health practitioners provide the unique ability to draw together social, economical and industrial infrastructure, and create preventative mental health models that protect,not only those with mental health issues, but aid all those who are most vulnerable in our society.

The Intergovernmental Panel on Climate Change (IPCC), which is the body recognised as the international authority on climate change, concludes that global warming is definitely occurring and that it will increase the likelihood of more extreme hot weather in the future (Solomonet al., 2007). The public health community and mental health community need to collaborate. We need to reduce the societal impact of extreme heat. We need to be proactive in protecting those who are most vulnerable,rather than the traditional methods of being reactive to extreme weather events. Research into heat waves needs to move away from exposing 'who isvulnerable?' and progress onward to discovering 'how effective is our community mental health, preventative health care, and health promotion programs at reaching those who are most vulnerable?'


Holt, M, Treloar, C, McMillan, K, Schultz, L, Schultz, M, & Bath,N. (2007). Barriers & Incentives to treatment for Illicit Drug Users with Mental Health Comorbidities and Complex Vulnerabilities National DrugStrategy (Vol. 61). Canberra: Department of Health and Ageing.

Kovats, R, & Hajat, S. (2008). Heat Stress and Public Health: A Critical Review. Annual Review of Public Health(29), 41-55.

Loughnan, M, Tapper, N, Phan, T, Lynch, K, & McInnes, J (Producer). (2012). A spatial vulnerability analysis of urban populations to extreme heat events in Australian capital cities.

McCoy, C, Metsch, L, Chitwood, D, & Miles, C. (2001). Drug Use and Barriers to use Health Care Services. Substance Use Misuse(36), 789-806.

Solomon, S, Qin, D, Manning, M, Chen, Z, Marquis, M, Averyt, M, . . .H, Miller. (2007). Climate Change 2007: The Physical Science Basis. In IPSS (Ed.), Summary for Policy Makers., in Climate Change 2007: The PhysicalScience Basis. Contribution of Working Group 1 to the Fourth Assessment. UK & NY: Cambridge University Press.

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