Introduction
Anthropogenic climate changes have been identified by the United Nations and the World Health Organization as “the defining issue of our time” and “the greatest threat to global health in the 21st century” [1–5]. Although most of the attention has been placed on physical health impacts of climate changes, mental health challenges are also expected to increase [Reference Türkarslan, Kozak and Yıldırım6–Reference Parker, Wellbery and Mueller10].
Climate change can affect mental health directly due to acute events (e.g., the development of a post-traumatic stress disorder [PTSD] after climate-related disaster exposure), or indirectly through slow-moving consequences of climate change on landscape or agriculture (e.g., the development of psychological distress among indigenous people due to drought, the rising of sea levels, or the loss of biodiversity). However, even without experiencing the direct or indirect effects of climate change, simply the awareness or perception of climate change as a global environmental threat through media consumption (including newspapers, scientific articles, social media, radio, television, and the internet) and/or social interactions also can have a psychological impact on people’s mental health [Reference Léger-Goodes, Malboeuf-Hurtubise, Mastine, Généreux, Paradis and Camden8, Reference Martin, Reilly, Everitt and Gilliland9, Reference Gianfredi, Mazziotta, Clerici, Astorri, Oliani and Cappellina11–Reference Berry, Bowen and Kjellstrom28].
Public awareness of the effects of climate change is rising due to growing media coverage of climate change-related consequences [Reference Léger-Goodes, Malboeuf-Hurtubise, Mastine, Généreux, Paradis and Camden8, Reference Baudon and Jachens29]. Since 2007, media reports on climate change have increased by almost 80% [Reference Hayes, Blashki, Wiseman, Burke and Reifels30]. Moreover, media dissemination of information about climate change frequently contains items highlighting the likely negative, even catastrophic consequences of these changes [Reference Jones, Wootton, Vaccaro and Menzies27]. This explains why large-scale survey studies have shown that the majority of people believe that climate change is a global emergency [Reference Lewandowski, Clayton, Olbrich, Sakshaug, Wray and Schwartz31, Reference Tam, Chan and Clayton32].
Although people with preexisting (severe) mental illness are particularly vulnerable to the direct and indirect impacts of climate change [Reference Betro’13, Reference Braithwaite16, Reference Georgiou, Xekalakis and Parlalis33–Reference Woodland, Ratwatte, Phalkey and Gillingham35], they may also be more vulnerable to increased psychological distress as a consequence of thinking about the future threat that climate change poses [Reference Jones, Wootton, Vaccaro and Menzies27, Reference Aktaş, Ayhan and Karan36–Reference Taylor41]. Constant media exposure to these sources of information and images may engender anxiety, depressive, or stressful symptoms [Reference Stokols, Misra, Runnerstrom and Hipp42], possibly leading to an exacerbation of their disease [Reference Croasdale, Grailey, Jennings, Mole and Lawrance17, Reference Cianconi, Betrò and Janiri23, Reference Lawrance, Jennings, Kioupi, Thompson, Diffey and Vercammen43, Reference Every-Palmer, McBride, Berry and Menkes44]. However, little is known about the relationship between climate change awareness-related psychological distress (CCARPD) and the mental health of people with preexisting mental illness. Therefore, the objective of this study was to conduct a scoping review to systematically map the research done on the association between CCARPD and the mental health of people with preexisting lifetime or current mental illness, as well as to identify the existing gaps in this research. Due to the expected small number of studies available in this research field, we decided to include also studies using samples of people with mental health vulnerabilities from the general population (i.e., people with subclinical symptoms or people having previously received treatment or support for mental health problems/diagnoses undermining daily functioning).
Methods
This scoping review was conducted according to the 2018 Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines [Reference Tricco, Lillie, Zarin, O’Brien, Colquhoun and Levac45], and the 2020 scoping reviews chapter in the JBI Manual for Evidence Synthesis [Reference Peters, Godfrey, McInerney, Munn, Tricco, Khalil, Aromataris and Munn46], which is congruent with the PRISMA-ScR checklist. The protocol was registered with the Open Science Framework initiative (https://osf.io/t59mg/) on May 5, 2023.
Search strategy
A comprehensive and systematic literature search in PubMed (via NCBI, including MEDLINE), Embase (Embase.com), Web of Science Core Collection (SCI-EXPANDED, SSCI, AHCI, CPCI-S, CPCI-SSH, ESCI), Scopus (Scopus.com), and CENTRAL (via Cochrane Library) electronic databases (from inception to February 2025) was conducted on April 13, 2023 (with updates on July 1, 2024 and February 27, 2025). The search was performed without language restriction to identify records assessing the association between CCARPD and the mental well-being of people with psychiatric diagnoses or subclinical symptoms in psychiatric and general populations. Four of the authors, of whom two are experienced biomedical information specialists, closely worked together to construct search strings for the different databases. Full search strings are available in the Supplementary Material. Duplicates of the original search were removed, using EndNote 20 (based on the instructions provided by Leeds University Library).Footnote 1 After removing duplicates, titles and abstracts were screened, using Rayyan QCRI. Articles that were deemed potentially relevant according to the selection criteria were included. Any doubts were solved by consensus or by decision of a second and/or third reviewer. We also attempted to identify additional studies through a process of backward citation searching, using the references of identified relevant reports on CCARPD and mental health [Reference Hirt, Nordhausen, Fuerst, Ewald and Appenzeller-Herzog47].
Selection criteria
All inclusion and exclusion criteria are presented in Table 1. We included studies exploring the relationship between CCARPD (anxiety, depression, and/or stress) and the mental health of people with preexisting or probable mental illness. CCARPD operates along a single continuum from mild concern to severe psychological distress [Reference Hannachi, Yakimova and Somat49]. As clinicians, we decided to focus on the more severe forms of CCARPD, as these are especially relevant as indicators of poor mental health [Reference Chan, Lin, Tam and Hong50–Reference Whitmarsh, Player, Jiongco, James, Williams and Marks54]. Environmental worry or concern, a cognitive phenomenon with affective repercussions but without interfering with one’s daily functioning [Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Gago and Sá56], for example, is often considered to be a less severe form of CCARPD [Reference Chan, Lin, Tam and Hong50, Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Stewart, Chapman and Davis57]. Therefore, we only included studies using at least some functional impairment measure [Reference Owczarek, Redican, Shevlin and Nolan48], meaning that the CCARPD had to interfere with a person’s ability to work, study or socialize, leading to a reduction in quality of life.
Table 1. Inclusion and exclusion criteria of studies
Abbreviations: CCARPD, Climate Change Awareness-Related Psychological Distress; MDD, Major Depressive Disorder; N/A, Not Applicable.
Data extraction
Data were extracted and mapped descriptively by JD, using a data extraction form, one for studies done within the general population, and one for studies within the clinical population. This extraction form included the following information:
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- author(s);
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- country (where the study was conducted);
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- study design;
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- patient characteristics (sample size, female gender, mean age, specific information on clinical symptoms, or previous psychological support);
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- information on screening tools and on outcomes collected as an exposure or mental health outcome;
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- outcomes/key findings that relate to the scoping review questions.
As a meta-analysis was not feasible, due to the expected high methodological heterogeneity between studies, descriptive statistics were used to summarize study and patient characteristics.
Results
Search strategy
The search in PubMed (n = 3,156), Embase (n = 3,990), Web of Science Core Collection (n = 10,239), Scopus (n = 10,461), and Cochrane (n = 201) databases yielded a total of 28,047 reports. From these, 12,869 duplicates were removed. Overall, 795 references of published records were selected as potentially eligible, of which 67 records [Reference Türkarslan, Kozak and Yıldırım6, Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Jones, Wootton, Vaccaro and Menzies27, Reference Lawrance, Jennings, Kioupi, Thompson, Diffey and Vercammen43, Reference Chan, Lin, Tam and Hong50–Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Lau, Appiah, Ho, Cheng and Yang58–Reference Gebhardt, Schwaab, Friederich and Nikendei114] met the inclusion criteria. One record [Reference Cameron and Kagee61] was identified through backward citation searching. The results of the study selection are shown in the PRISMA flowchart (see Figure 1).
Figure 1. PRISMA flowchart.
Study and patient characteristics
Sixty-seven records were included in this scoping review (see Tables 2–4). Sixty-four studies were conducted in the general population; three concerned psychiatric population studies. Most general population studies had a cross-sectional design (n = 61) (of which one [Reference Carlson, Foley and Fang77] also included MRI data, two [Reference Hajek and König104, Reference Hajek and König105] were based on the same patient population, and three [Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Vercammen, Oswald and Lawrance96, Reference Hogg, Stanley, O’Brien, Wilson and Watsford110] had a mixed methods design (presenting quantitative and qualitative data). Veijonaho et al. [Reference Veijonaho, Ojala, Hietajärvi and Salmela-Aro81], Whitmarsh et al. [Reference Whitmarsh, Player, Jiongco, James, Williams and Marks54], and Chan et al. [Reference Chan, Lin, Tam and Hong50] were longitudinal studies. Two of the psychiatric population records were cross-sectional studies [Reference Lerolle, Micoulaud-Franchi, Fourneret, Heeren and Gauld113, Reference Gebhardt, Schwaab, Friederich and Nikendei114], one [Reference Jones, Wootton, Vaccaro and Menzies27] a naturalistic study. Mean age of the participants for the general and psychiatric population studies (N = 47,687) was 32 years (range: 14–55 years). Sample sizes ranged from 42 to 3,091 participants. All studies, except the Yesildere Saglam and Sahin [Reference Yesildere Saglam and Mizrak Sahin62], Chan et al. [Reference Chan, Tam and Clayton67], Weiß et al. [Reference Weiß, Gutzeit and Hein70], Hogg et al. [Reference Hogg, Stanley and O’Brien75], Veijonaho et al. [Reference Veijonaho, Ojala, Hietajärvi and Salmela-Aro81], Lukacs et al. [Reference Lukacs, Bratu, Adams, Logie, Tok and McCunn98], Feather and Williams [Reference Feather and Williams103], Hajek and König [Reference Hajek and König104, Reference Hajek and König105], Clayton and Karazsia [Reference Clayton and Karazsia112], and Jones et al. [Reference Jones, Wootton, Vaccaro and Menzies27] studies, included more female participants (mean: 63,8%). Forty percent of the studies were conducted in Europe (Germany, n = 12; France, n = 6; Italy, n = 3; Poland, n = 4; Slovenia, n = 1; Finland, n = 1). The other studies were done in Australia/New Zealand (n = 9), the United States (n = 5), Turkey (n = 6), Canada (n = 4), the United Kingdom (n = 3), China (n = 2), Lebanon (n = 2), Libya (n = 1), South Africa (n = 1), or multiple countries (n = 7). Most studies used specifically designed scales to measure climate change anxiety, which were in most cases the Climate Change Anxiety Scale (CCAS) (n = 44) and the Hogg Eco-Anxiety Scale (n = 15). Three studies used the Climate Distress Scale, two the Eco-Anxiety Questionnaire and one the Climate Change Distress and Impairment Scale. Nearly three-fourth of the non-clinical population studies (n = 33) measured two or more categories of symptoms (i.e., depression, anxiety, and/or stress), using one or more of the above-mentioned scales.
Table 2. Study and patient characteristics of studies in general population individuals with subclinical symptoms or mental diagnoses [Reference Türkarslan, Kozak and Yıldırım6, Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Lawrance, Jennings, Kioupi, Thompson, Diffey and Vercammen43, Reference Chan, Lin, Tam and Hong50–Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Lau, Appiah, Ho, Cheng and Yang58–Reference Clayton and Karazsia112]
Abbreviations: BDI-II, Beck Depression Inventory-II; BFI-10, Short 10-item Big Five Inventory; BFI-15, Short 15-item Big Five Inventory; BHS, Beck Hopelessness Scale; BSI, Brief Symptom Inventory; CCA, Climate Change Anxiety; CCARS, Climate Change Awareness-Related Distress; CCAS, Climate Change Anxiety Scale; CCAS-S, Climate Change Anxiety Scale Short-Form (abbreviated 4-item version of the CCAS); CCDIS, Climate Change Distress and Impairment Scale; CDS, Climate Distress Scale; CES-D-10, Center for Epidemiologic Studies Depression Scale, 10-item version; CES-D-8, Center for Epidemiologic Studies Depression Scale, 8-item version; CSD, Cross-Sectional Design; DASS-8, Depression Anxiety Stress Scale, 8-item version; DASS-21, Depression Anxiety Stress Scale, 21-item version; DASS-42, Depression Anxiety Stress Scale, 42-item version; DEPS-10, The Depression Scale, 10-item version; DERS-SF, Difficulties in Emotion Regulation Scale – Short Form; DT, Distress Thermometer; EAQ-22, Eco-Anxiety Questionnaire; EID, Environmental Identity Scale; EMEA, Eco-Anxiety Measurement Scale; EPDS, Edinburgh Postnatal Depression Scale; GAD, General Anxiety Disorder; GAD-9, General Anxiety Disorder scale, 9-item version; GAD-7, General Anxiety Disorder scale, 7-item version; GAD-7-C, The climate change specific General Anxiety Disorder scale, 7-item version; GAD-2, General Anxiety Disorder scale, 2-item version; GAD-4, General Anxiety Disorder scale, 4-item version; HAD, Hospital Anxiety and Depression Scale; HEAS, Hogg Eco-Anxiety Scale; K-10, Kessler Psychological Distress Scale, 10-item version; K-6, Kessler Psychological Distress Scale, 6-item version; MDD, Major Depressive Disorder; MHC-SF, Mental Health Continuum-Short Form; MHW-12, Modern Health Worries scale (12 questions); MRI, Magnetic Resonance Imaging; MMS, Mixed-Methods Study; NEO-FFI, NEO Five-Factor Inventory; NR, Not Reported; PANAS-X, Positive and Negative Affect Schedule- expanded form; PHQ-4, Patient Health Questionnaire for depression and anxiety, 4-item version; PHQ-8, Patient Health Questionnaire for depression, 8-item version; PHQ-9, Patient Health Questionnaire for depression, 9-item version; PHQ-9-C, The climate change specific Patient Health Questionnaire for depression, 9-item version; PMS, Premenstrual Syndrome; PMSS, Premenstrual Syndrome Scale; PQ-B, Prodromal Questionnaire-Brief; PSIS, Perceived Social Isolation Scale; PSS-4, Perceived Stress Scale, 4-item version; PSWQ, Penn State Worry Questionnaire; PSQ-20, Perceived Stress Questionnaire, 20-item version; PSQ-20-C, the climate change specific Perceived Stress Questionnaire, 20-item version; PTSD-8, Post-Traumatic Stress Disorder, 8-item questionnaire; PTSS-10, Posttraumatic Stress Scale, 10-item version; PTSS-10-C, The climate change specific Posttraumatic Stress Scale, 10-item version; QDIA-SR, Quick Depression Inventory for Adolescents-Self-Report Form; SDA, Scale of Death Anxiety; SDES, Short Defeat and Entrapment Scale; SDQ, Strengths and Difficulties Questionnaire; SIBS, Suicide Ideation and Behavior Scale; SPANE, Scale of Positive and Negative Experiences; SSS-8, Somatic Symptoms Scale (8 categories of somatic symptoms); STAIT-5, State-Trait Anxiety Inventory Scale-5 questionnaire; STAI-Y, Spielberger Trait Anxiety Scale-Form Y; UK, United Kingdom; US, United States; WHO-5, World Health Organization-Five Well-Being Index.
a Since the initial data were collected during the COVID-19 pandemic, potentially affecting climate anxiety levels, the sample was recontacted in late May 2022 to complete the climate anxiety measure a second time; 891 respondents completed the measure. Three percent of the sample had experienced flood damage to their home or garden in the last 5 years.
Table 3. Results of studies in general population individuals with subclinical symptoms or mental diagnoses [Reference Türkarslan, Kozak and Yıldırım6, Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Lawrance, Jennings, Kioupi, Thompson, Diffey and Vercammen43, Reference Chan, Lin, Tam and Hong50–Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Lau, Appiah, Ho, Cheng and Yang58–Reference Clayton and Karazsia112]
Abbreviations: BDI-II, Beck Depression Inventory-II; BFI-10, Short 10-item Big Five Inventory; BFI-15, Short 15-item Big Five Inventory; BHS, Beck Hopelessness Scale; BSI, Brief Symptom Inventory; CCA, Climate Change Anxiety; CCARS, Climate Change Awareness-Related Distress; CCAS, Climate Change Anxiety Scale; CCAS-S, Climate Change Anxiety Scale Short-Form (abbreviated 4-item version of the CCAS); CCDIS, Climate Change Distress and Impairment Scale; CDS, Climate Distress Scale; CES-D-10, Center for Epidemiologic Studies Depression Scale, 10-item version; CES-D-8, Center for Epidemiologic Studies Depression Scale, 8-item version; CSD, Cross-Sectional Design; DASS-8, Depression Anxiety Stress Scale, 8-item version; DASS-21, Depression Anxiety Stress Scale, 21-item version; DASS-42, Depression Anxiety Stress Scale, 42-item version; DCE, Discrete Choice Experiment; DEPS-10, The Depression Scale, 10-item version; DERS-SF, Difficulties in Emotion Regulation Scale – Short Form; DT, Distress Thermometer; EAQ-22, Eco-Anxiety Questionnaire; EID, Environmental Identity Scale; EMEA, Eco-Anxiety Measurement Scale; EPDS, Edinburgh Postnatal Depression Scale; GAD, General Anxiety Disorder; GAD-2: General Anxiety Disorder scale, 2-item version; GAD-4: General Anxiety Disorder scale, 4-item version; GAD-7, General Anxiety Disorder scale, 7-item version; GAD-7-C, The climate change specific General Anxiety Disorder scale, 7-item version; GAD-9, General Anxiety Disorder scale, 9-item version; HAD, Hospital Anxiety and Depression Scale; HEAS, Hogg Eco-Anxiety Scale; K-6, Kessler Psychological Distress Scale, 6-item version; K-10, Kessler Psychological Distress Scale, 10-item version; MDD, Major Depressive Disorder; MHC-SF, Mental Health Continuum-Short Form; MHW-12, Modern Health Worries scale (12 questions); MMS, Mixed-Methods Study; MRI, Magnetic Resonance Imaging; NEO-FFI, NEO Five-Factor Inventory; NR, Not Reported; PANAS-X, Positive and Negative Affect Schedule- expanded form; PHQ-4, Patient Health Questionnaire for depression and anxiety, 4-item version; PHQ-8, Patient Health Questionnaire for depression, 8-item version; PHQ-9, Patient Health Questionnaire for depression, 9-item version; PHQ-9-C, The climate change specific Patient Health Questionnaire for depression, 9-item version; PMS, Premenstrual Syndrome; PQ-B, Prodromal Questionnaire-Brief; PSIS, Perceived Social Isolation Scale; PSS-4, Perceived Stress Scale, 4-item version; PSWQ, Penn State Worry Questionnaire; PSQ-20, Perceived Stress Questionnaire, 20-item version; PSQ-20-C, the climate change specific Perceived Stress Questionnaire, 20-item version; PTSD-8, Post-Traumatic Stress Disorder, 8-item questionnaire; PTSS-10, Posttraumatic Stress Scale, 10-item version; PTSS-10-C, The climate change specific Posttraumatic Stress Scale, 10-item version; QDIA-SR, Quick Depression Inventory for Adolescents-Self-Report Form; SDA, Scale of Death Anxiety; SDES, Short Defeat and Entrapment Scale; SDQ, Strengths and Difficulties Questionnaire; SIBS, Suicide Ideation and Behavior Scale; SPANE, Scale of Positive and Negative Experiences; SSS-8, Somatic Symptoms Scale (8 categories of somatic symptoms); STAIT-5, State-Trait Anxiety Inventory Scale-5 questionnaire; STAI-Y, Spielberger Trait Anxiety Scale-Form Y; UK, United Kingdom; US, United States; WHO-5, World Health Organization-Five Well-Being Index.
Table 4. Results of studies in the clinical population [Reference Jones, Wootton, Vaccaro and Menzies27, Reference Lerolle, Micoulaud-Franchi, Fourneret, Heeren and Gauld113, Reference Gebhardt, Schwaab, Friederich and Nikendei114]
Abbreviations: ADHD, Attention Deficit Hyperactivity Disorder; ASD, Autism Spectrum Disorder; BDI, Beck Depression Inventory; CIDI-Auto, The Composite International Diagnostic Interview; C-SSRS, Columbia-Suicide Severity Rating Scale; DASS-21, Depression Anxiety Stress Scale 21; GAD-7, General Anxiety Disorder scale, 7-item version; GAD-7-C, The climate change specific General Anxiety Disorder scale, 7-item version; HAD, Hospital Anxiety and Depression Scale; HEAS, The Hogg Eco-Anxiety Scale; MDD, Major Depressive Disorder; N/A, Not Applicable; OCD, Obsessive Compulsive Disorder; PHQ-9, Patient Health Questionnaire for depression, 9-item version; PHQ-9-C, The climate change specific Patient Health Questionnaire for depression, 9-item version; PTSD, Post-Traumatic Stress Disorder; PTSS-10, Posttraumatic Stress Scale, 10-item version; PTSS-10-C, The climate change specific Posttraumatic Stress Scale, 10-item version; PI-WSUR, Padua Inventory – Washington State University Revision; VOCI, Vancouver Obsessional Compulsive Inventory; Y-BOCS, Yale-Brown Obsessive Compulsive Scale.
Association between CCARPD and mental health in people with psychiatric diagnoses or subclinical symptoms
General population studies
The available evidence shows that in most general population studies [Reference Türkarslan, Kozak and Yıldırım6, Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Lawrance, Jennings, Kioupi, Thompson, Diffey and Vercammen43, Reference Wu, Long, Hafez, Maloney, Lim and Samji51, Reference Hepp, Klein, Horsten, Urbild and Lane52, Reference Whitmarsh, Player, Jiongco, James, Williams and Marks54, Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Lau, Appiah, Ho, Cheng and Yang58–Reference Cameron and Kagee61, Reference Shepherd, Raynal and Guedj64, Reference Wagner and Witthöft65, Reference Chan, Tam and Clayton67–Reference Zeier and Wessa78, Reference Çimşir, Şahin and Akdoğan80, Reference Orrù and Mannarini82, Reference Lykins, Bonich, Sundaraja and Cosh83, Reference Wullenkord, Johansson, Loy, Menzel and Reese85–Reference Micoulaud-Franchi, Coelho, Geoffroy, Vecchierini, Poirot and Royant-Parola88, Reference Nezlek and Cypryańska90, Reference Thomson and Roach93, Reference Mathers-Jones and Todd95, Reference Mathé, Grisetto, Gauvrit and Roger99, Reference Feather and Williams103–Reference Innocenti, Santarelli, Faggi, Castellini, Manelli and Magrini111] significant positive correlations were found between CCARPD and mental health measurements. These correlations, however, were mostly low (r < 0.30) to moderate (r = 0.30–0.49) (see Table 3). Trait anxiety, a personality trait to perceive various events as threatening [Reference Knowles and Olatunji115], also seems to play a minor role as a predictor of climate anxiety-related impairments [Reference Parmentier, Weiss, Aroua, Betry, Rivière and Navarro86].
Studies in general populations have also found that, although individuals at risk for mental illness may experience CCARPD, this distress rarely results in significant functional impairment. Only a minority of these individuals exhibited moderate or severe levels of distress in relation to climate change awareness [Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Wu, Long, Hafez, Maloney, Lim and Samji51, Reference Hepp, Klein, Horsten, Urbild and Lane52, Reference Whitmarsh, Player, Jiongco, James, Williams and Marks54, Reference Schwaab, Gebhardt, Friederich and Nikendei102]. Those who had a clinical history (i.e. previously receiving psychological support or having a mental health disorder) tended to experience higher distress levels due to the awareness of climate change [Reference Ediz and Yanik94, Reference Vercammen, Oswald and Lawrance96]. Vercammen et al. [Reference Vercammen, Oswald and Lawrance96], for example, found in their online survey that the subgroup of those currently diagnosed and/or receiving treatment for a mental health condition were significantly more likely to experience moderate (OR = 1.930) and high levels (OR = 3.116) of CCARPD.
Psychiatric population studies
We found a paucity of literature examining the association between CCARPD and the mental health of people with a preexisting psychiatric diagnosis within clinical populations. Only 3 out of the 67 identified records concerned psychiatric populations (see Table 4).
These studies [Reference Jones, Wootton, Vaccaro and Menzies27, Reference Lerolle, Micoulaud-Franchi, Fourneret, Heeren and Gauld113, Reference Gebhardt, Schwaab, Friederich and Nikendei114] illustrate how CCARPD can have an impact on the content of delusions held by people with a schizophrenia-spectrum disorder or a major depressive disorder with psychotic symptoms, or on the types of obsessions and compulsions experienced by people with obsessive-compulsive disorders. Jones et al. [Reference Jones, Wootton, Vaccaro and Menzies27] found that 28% of their obsessive-compulsive patients had obsessions and compulsions directly related to climate change (such as the obsession that increased air temperatures would result in rapid evaporation of the water in their pet bowls, leading to their pets dying of thirst, followed by checking and rechecking the pet’s water bowl to ensure they held adequate water).
The type of cognitive biases contributing to depressive, anxiety or PTSD symptoms seems to be related to the type of climate change awareness-related symptoms. The study of Gebhardt et al. [Reference Gebhardt, Schwaab, Friederich and Nikendei114], for example, showed patients with depression might focus more on the sadness-related feelings evoked by climate change awareness, whereas those with anxiety disorder or PTSD rather had threat-related feelings evoked by climate change awareness.
Discussion
The positive, but mostly small-to-moderate, correlations between CCARPD and mental health measurements (anxiety, depressive, or stress symptoms) that have been observed across general and psychiatric population studies are in line with those of other recent reviews with distinct research questions and methods [Reference Gago, Sargisson and Milfont116, Reference Cosh, Ryan, Fallander, Robinson, Tognela and Tully117]. The systematic review of Cosh et al. [Reference Cosh, Ryan, Fallander, Robinson, Tognela and Tully117] reported small-to-large positive correlations (r = 0.14 to r = 0.60) between eco-anxiety and depressive, anxiety, or stress symptoms in general population and mental health settings. Eco-anxiety in this review, however, was broadly defined and also included environmental worry, probably explaining why associations with mental health outcomes were more variable than in our review. Moreover, probably partly due to a less extensive and updated search strategy, only 35 studies were included in their review. Gago et al. [Reference Gago, Sargisson and Milfont116], finding a moderate negative correlation (r = −0.30) between eco-anxiety and psychological well-being, limited their analyses to eco-anxiety as measured by the CCAS. Despite this, all these results suggest that people with mental health vulnerabilities may be more prone to experience higher levels of CCARPD and functional impairment. However, as these data are cross sectional, they are insufficient to establish a causal relationship between potential or preexisting psychopathology and higher levels of CCARPD. It is plausible that people with mental health vulnerabilities look at climate change-related events with a general negative bias, leading to higher states of anxiety, depression, and/or stress. On the other hand, it is also likely that the awareness of climate-related changes is potentially stressful and detrimental to overall mental health and particularly might be a risk factor for these individuals. The resulting negative thoughts and feelings may as such contribute to the exacerbation or even the development of psychiatric disorders. There might also be a bidirectional association between both variables [Reference Ogunbode, Pallesen, Böhm, Doran, Bhullar and Aquino21, Reference Ogunbode, Doran and Böhm22, Reference Hogg, Stanley and O’Brien75, Reference Zeier and Wessa78, Reference Er, Murat, Ata, Köse and Buzlu89, Reference Hogg, Stanley and O’Brien118–Reference Searle and Gow120].
There is still little consensus on how to conceptualize CCARPD from a mental health standpoint [Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Vukičević and Liu121]. Most authors, mental health professionals, and climate scientists [Reference Türkarslan, Kozak and Yıldırım6–Reference Martin, Reilly, Everitt and Gilliland9, Reference Treble, Cosma and Martin15, Reference Croasdale, Grailey, Jennings, Mole and Lawrance17, Reference Trost, Ertl, König, Rosner and Comtesse37, Reference Lawrance, Jennings, Kioupi, Thompson, Diffey and Vercammen43, Reference Carlson, Foley and Fang77, Reference Veijonaho, Ojala, Hietajärvi and Salmela-Aro81, Reference Hogg, Stanley, O’Brien, Watsford and Walker84, Reference Nezlek and Cypryańska90, Reference Patrick, Snell, Gunasiri, Garad, Meadows and Enticott92, Reference Heinzel, Tschorn, Schulte-Hutner, Schäfer, Reese and Pohle97, Reference Hogg, Stanley, O’Brien, Wilson and Watsford110, Reference Gago, Sargisson and Milfont116, Reference Butler and Rao122–Reference Verplanken and Roy130] agree that emotional reactions to climate change should not be pathologized and can be seen as an adequate, adaptive, functional, justifiable, and rational response to the serious threats facing the planet and its inhabitants. Moreover, some [Reference Dodds131] have even argued that it might be pathological to have too little CCARPD, given the urgency of climate action.
There is no doubt that climate change poses an existential threat to humans and other living organisms [Reference Passmore, Lutz and Howell132, Reference Ramadan and Ataallah133]. The global ecological crisis has indeed been related to many existential concerns and deep feelings of ontological insecurity [Reference Wullenkord, Tröger, Hamann, Loy and Reese109, Reference Panu129, Reference Hajek and König134, Reference Laing135]. This existential threat challenges prevailing values, ethics, and way of thinking and imposes a set of constraints on human behavior (such as [mental] health and forced migration) and basic preconditions (such as food security) [Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Crandon, Scott, Charlson and Thomas125, Reference Ramadan and Ataallah133]. Given its existential nature, it is not surprising and quite plausible that CCARPD is experienced by numerous people who do not suffer from mental health issues.
However, irrespective of whether it represents a rational concern, results highlight that CCARPD may also be overwhelming, “irrationally high,” excessive, and uncontrollable, and may reach levels that interfere with an individual’s ability to function, especially for people with underlying symptoms of anxiety, depression, or stress [Reference Türkarslan, Kozak and Yıldırım6, Reference Ramadan, Randell, Lavoie, Gao, Manrique and Anderson7, Reference Martin, Reilly, Everitt and Gilliland9, Reference Treble, Cosma and Martin15, Reference Croasdale, Grailey, Jennings, Mole and Lawrance17, Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Trost, Ertl, König, Rosner and Comtesse37, Reference Lawrance, Thompson, Newberry Le Vay, Page and Jennings39, Reference Cosh, Williams, Lykins, Bartik and Tully63, Reference Veijonaho, Ojala, Hietajärvi and Salmela-Aro81, Reference Wullenkord, Johansson, Loy, Menzel and Reese85, Reference Patrick, Snell, Gunasiri, Garad, Meadows and Enticott92, Reference Heinzel, Tschorn, Schulte-Hutner, Schäfer, Reese and Pohle97, Reference Clayton and Karazsia112, Reference Gago, Sargisson and Milfont116, Reference Crandon, Scott, Charlson and Thomas125, Reference Cunsolo, Harper, Minor, Hayes, Williams and Howard128, Reference Magruder and Chipman136, Reference Christodoulou, Laaidi and Geoffroy137].
Several studies found a strong association between CCARPD and pro-environmental attitudes or behaviors, even when controlling for several correlates of environmental behavior (e.g., political ideology) [Reference Schwartz, Benoit, Clayton, Parnes, Swenson and Lowe18, Reference Tucholska, Gulla and Ziernicka-Wojtaszek74, Reference Hogg, Stanley, O’Brien, Watsford and Walker84, Reference Wullenkord, Tröger, Hamann, Loy and Reese109, Reference Hogg, Stanley, O’Brien, Wilson and Watsford110, Reference Verplanken and Roy130, Reference Ballew, Uppalapati, Myers, Carman, Campbell and Rosenthal138], suggesting that CCARPD may be a constructive form of distress and stimulate individuals to adopt behaviors that can counteract climate change (identified as the concerned steward effect or a coping mechanism) [Reference Lukacs, Bratu, Adams, Logie, Tok and McCunn98, Reference Innocenti, Perilli, Santarelli, Carluccio, Zjalic and Acquadro Maran100, Reference Wullenkord, Tröger, Hamann, Loy and Reese109]. Thus, it seems that low-to-moderate levels of CCARPD (particularly anxiety symptoms) may be essential and required to take ecological problems seriously and engage in pro-environmental behaviors. High or excessive levels of CCARPD, however, can have a paralyzing effect on pro-environmental behaviors [Reference Innocenti, Perilli, Santarelli, Carluccio, Zjalic and Acquadro Maran100, Reference Heeren, Mouguiama-Daouda and Contreras101, Reference Wullenkord, Tröger, Hamann, Loy and Reese109, Reference Christodoulou, Laaidi and Geoffroy137]. Heeren et al. [Reference Heeren, Mouguiama-Daouda and Contreras101] have shown that the relationship between CCARPD and pro-environmental behavior is weakest in individuals with the highest levels of CCARPD, suggesting that CCARPD in cases of high anxiety levels is not adaptive. Symptoms of CCARPD may also be more pronounced in individuals who lack emotional regulation skills. Emotional regulation is the individual’s ability to identify and regulate the emotions they have. In those with high levels of emotion dysregulation, climate change awareness-related anxiety may reach levels that deteriorate daily functioning, predicting worse mental health outcomes [Reference Orrù and Mannarini82].
An important question here is whether CCARPD also deserves a special status (as a separate disorder) in the existing psychiatric classifications [Reference Gregersen, Doran, Ogunbode and Böhm139]. Some health professionals, for example, see CCARPD as a form of “pre-traumatic stress disorder,” in which traumatic consequences are anticipated and felt (i.e., pre-traumatic stress symptoms, including patterns of avoidance and symptoms of hypervigilance) before the event even takes place [Reference Baudon and Jachens29, Reference Patrick, Snell, Gunasiri, Garad, Meadows and Enticott92, Reference Babbott140]. However, until now, current diagnostic manuals (i.e., the DSM-5-TR and ICD-11) do not include ecological disorders such as eco-anxiety or climate change awareness-related phobia, depression, or obsessions/compulsions [Reference Magruder and Chipman136].
Given that various environmental issues are expected to worsen and humanity does not presently seem able to stop it effectively, CCARPD is likely to become a greater focus for mental health professionals and psychotherapists in the coming years [Reference Croasdale, Grailey, Jennings, Mole and Lawrance17, Reference Baudon and Jachens29, Reference Trost, Ertl, König, Rosner and Comtesse37, Reference Lutz, Passmore, Howell, Zelenski, Yang and Richardson55, Reference Raile141]. Mental health professionals and psychotherapists already are increasingly reporting counseling individuals dealing with CCARPD [Reference Martin, Reilly, Everitt and Gilliland9, Reference Trost, Ertl, König, Rosner and Comtesse37, Reference Lawton142, Reference Budziszewska and Jonsson143]. In a nationwide sample of German psychotherapists (N = 573), for example, about 72% of them indicated having patients with climate change-related concerns [Reference Trost, Ertl, König, Rosner and Comtesse37]. Findings suggest, however, that these issues are not yet adequately addressed in psychotherapy [Reference Bahar, Rego and Sadeh-Sharvit144]. Psychotherapists therefore should be prepared to address them.
The development of psychotherapeutic interventions to address the adverse mental health effects of climate changes have already been indicated by the American Psychiatric Association and the European Psychiatric Association as a legitimate focus of psychiatrists and psychologists [Reference Brandt, Adorjan, Catthoor, Chkonia, Falkai and Fiorillo145–Reference Vidal and Latkin147], hereby emphasizing a salutogenic (i.e., identifying and promoting factors that contribute to well-being), rather than a pathogenic approach [Reference Patrick, Snell, Gunasiri, Garad, Meadows and Enticott92, Reference Pitt, Norris and Pecl123]. Acceptance and commitment therapy, for example, may be appropriate, as it focuses on validating experienced emotions and changing the individual’s relationship to their thoughts and cognitions, rather than questioning their validity. It also encourages patients to be fully engaged and present in the current moment, rather than dwelling on the past (e.g., eco-grief) or worrying about the future (e.g., eco-anxiety), and to take action to address environmental issues [Reference Croasdale, Grailey, Jennings, Mole and Lawrance17, Reference Hogg, Stanley, O’Brien, Watsford and Walker84, Reference Magruder and Chipman136]. According to Hogg et al. [Reference Hogg, Stanley, O’Brien, Watsford and Walker84], components of Dialectical Behavior Therapy that help people develop insight into their CCARPD (e.g., what triggers it, how it manifests, what its function is) may also indirectly benefit well-being. Several other therapies, including environmental identity-based therapies [Reference Doherty and Clayton148], nature-based art therapy [Reference Wardle149], and the CliMACT training [Reference Reininghaus150], are explored to see how they can support people with CCARPD within the context of the ecological crisis. Interventions involving cognitive reappraisal of anxiety-provoking objects as less threatening, on the other hand, may not be appropriate given the genuine threat of climate change [Reference Mathers-Jones and Todd95]. Making individual behavioral changes to cut one’s global footprint may be seen as another way of decreasing climate change anxiety because the person now feels that they are helping to address the problem. However, for people with obsessive compulsive disorder, it is possible that this approach can actually exacerbate the anxiety and contribute to further checking [Reference Jones, Wootton, Vaccaro and Menzies27].
This scoping review identified several research gaps. First, concept and terminology of CCARPD needs to be better defined [Reference Owczarek, Redican, Shevlin and Nolan48, Reference Orrù and Mannarini82, Reference van Dijk, van Schie, Smeets and Mertens151], as it may restrict replicability and comparability of studies [Reference van Dijk, van Schie, Smeets and Mertens151]. There exists still no formal definition of CCARPD [Reference Lawton142]. According to Orrù and Mannarini [Reference Orrù and Mannarini82] more than ten distinct operationalizations of this concept are currently used in the literature. This is reflected in the diverse ranges of measures, complicating efforts to compare findings across studies [Reference Owczarek, Redican, Shevlin and Nolan48, Reference van Dijk, van Schie, Smeets and Mertens151]. Second, more research on the association between CCARPD and mental health in people is necessary, particularly in clinical populations and young people. Moreover, future research should also examine how one can help these people cope with negative emotions about climate change and explore the role of mental practitioners herein. Third, most of the conducted studies have a cross-sectional design. This design cannot be used to infer causality between CCARPD and mental health. It is therefore impossible to understand how CCARPD and mental health affect each other over time [Reference Jarrett, Gauthier, Baden, Ainsworth and Dorey152]. Longitudinal studies to assess the direction(s) of causality between CCARPD and mental disorders therefore are needed, as well as specific studies examining the role of coping strategies (coping strategies people use to reduce their anxiety over time cannot be uncovered in cross-sectional designs) [Reference Wullenkord, Tröger, Hamann, Loy and Reese109]. Fourth, several studies, particularly those in the United States and Australia, may have some bias selection toward direct and/or indirect consequences of climate change. As particularly these areas are affected by climate change such as bushfires, floods, and extreme heat waves, one can wonder whether the included studies only measured climate change awareness or also direct and indirect effects of climate change. A nation-wide Australian study [Reference Patrick, Snell, Gunasiri, Garad, Meadows and Enticott92], approximately representative of adults in Australia, showed that in their large sample the majority of Australians (54.63%) already had a direct experience of a climate change-related event (e.g., directly affected by bushfire, flood, extreme heat wave). Another limitation is the methodological problem of self-report bias in the selected studies. It is important to know that all psychological scales that have been used in non-clinical population studies are self-report measures of anxiety or depressive symptoms and only indicative for clinically confirmed psychiatric diagnoses such as generalized anxiety disorder. Respondents may also underreport symptoms of mental health disorders, potentially weakening study measures [Reference Hunt, Auriemma and Cashaw153]. Future general population studies therefore should try to use other measures, such as structural mental health interviews [Reference Wu, Long, Hafez, Maloney, Lim and Samji51]. Finally, studies examining the association between CCARPD and mental health also fail to explicitly account for differences in the content and valence of climate change information conveyed to audiences by the media. Not only the mere volume of media exposure, but also the content of the information and the amount of attention people pay to it is important. Some studies suggest that media attention may be a better predictor of CCARPD than media exposure alone [Reference Whitmarsh, Player, Jiongco, James, Williams and Marks54, Reference Ogunbode, Doran, Hanss, Ojala, Salmela-Aro and van den Broek154].
A key strength of this review certainly is the extensive search strategies, including several databases (see Supplementary Material) to identify relevant studies on this topic. The search was also performed without language restrictions. Although we included studies with a mixed methods design, a major limitation is that our primary goal was to collect and analyze numerical, quantitative data. The inclusion of more qualitative data probably would have provided more in-depth, rich insights into the complex associations between CCARPD and mental health.
Conclusion
Although CCARPD in most cases represents a reasonable and comprehensible reaction to serious environmental issues, our review shows that it can still be dysfunctional for people with mental health vulnerabilities, sometimes requiring professional support. As CCARPD will increase globally as the climate crisis unfolds in the coming decades while the understanding of the connections between CCARPD and mental well-being is still at an early stage of development, more research will be of utmost relevance. Particularly research in psychiatric populations is urgently needed to investigate how CCARPD may contribute to the exacerbation or reemergence of preexisting psychiatric disorders and how standard psychotherapeutic interventions should be adapted to address CCARPD in these populations successfully. In this regard, the development of clinical cut-off scores for CCARPD (such as these proposed by the systematic review of Cosh et al. [Reference Cosh, Williams, Lykins, Bartik and Tully63], i.e., ≥21 on the CCAS for mild-moderate CCARPD, and ≥23 on the CCAS for severe-extremely severe CCARPD) may be opportune to guide clinical practice.
Supplementary material
The supplementary material for this article can be found at http://doi.org/10.1192/j.eurpsy.2026.10169.
Data availability statement
The search strings are available as supplementary material.
Author contribution
H.P, J.D., K.C., K.V.d.B, M.D.H., and M.M. conceptualized the study. J.D., V-E. B., T.V., and C.V.M. outlined the search strategy. J.D. performed the literature search and wrote the draft of the manuscript. All authors gave their feedback on the drafts of the manuscript. J.D. revised the manuscript. All authors have read and approved the manuscript.
Financial support
This work has been financed by an unrestricted grant from Johnson & Johnson and Lundbeck.
Competing interests
The authors declare that there are no conflicts of interest relevant to this work.
Financial disclosures for the previous 12 months
All authors declare that there are no additional disclosures to report.
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