Abstract
BackgroundAir pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. Our aim was to investigate associations between daily fluctuations in air pollution concentrations and the daily number of visits to a psychiatric emergency unit.MethodsData from Sahlgrenska University Hospital, Gothenburg, Sweden, on the daily number of visits to the Psychiatric emergency unit were combined with daily data on monitored concentrations of respirable particulate matter(PM10), ozone(O3), nitrogen dioxides(NO2) and temperature between 1st July 2012 and 31st December 2016. We used a case-crossover design to analyze data with conditional Poisson regression models allowing for over-dispersion. We stratified data on season.ResultsVisits increased with increasing PM10 levels during the warmer season (April to September) in both single-pollutant and two-pollutant models. For example, an increase of 3.6% (95% Confidence Interval, CI, 0.4–7.0%) was observed with a 10 μg/m3 increase in PM10 adjusted for NO2. In the three-pollutant models (adjusting for NO2 and O3 simultaneously) the increase was 3.3% (95% CI, −0.2-6.9). There were no clear associations between the outcome and NO2, O3, or PM10 during the colder season (October to March).ConclusionsAmbient air particle concentrations were associated with the number of visits to the Psychiatric emergency unit in the warm season. The results were only borderline statistically significant in the fully adjusted (three-pollutant) models in this small study. The observation could be interpreted as indicative of air pollution as either exacerbating an underlying psychiatric disorder, or increasing mental distress, even in areas with comparatively low levels of air pollution. In combination with the severe impact of psychiatric disorders and mental distress on society and individuals, our results are a strong warrant for future research in this area.
Highlights
Air pollution is one of the leading causes of mortality and morbidity worldwide
We aim to investigate acute effects of air pollution on worsening of psychiatric disorders or of mental distress, using daily levels of air pollution concentrations together with the daily number of Gothenburg municipality residents who seek care at the psychiatric emergency department at Sahlgrenska University Hospital in Gothenburg
In single-pollutant unadjusted models the daily lag 0 PM10 concentrations were statistically significantly associated with the daily number of Psychiatric emergency visit (PEV) with a 2.1% increase (95% Confidence Interval, CI, of 0.2–4.0%, Table 2)
Summary
Air pollution is one of the leading causes of mortality and morbidity worldwide. Experimental studies, and a few epidemiological studies, suggest that air pollution may cause acute exacerbation of psychiatric disorders, and even increase the rate of suicide attempts, but epidemiological studies on air pollution in association with psychiatric disorders are still few. For which there is emerging evidence of a relation to psychiatric disorders or mental distress, is ambient air pollution. Associations between long-term exposure to air pollution and perceived stress and prevalent anxiety, [13, 14] with risk of schizophrenia, [15] and with depressive and anxiety symptoms [16] have been reported. In addition to effects of long-term exposure, acute associations between ambient air pollution and psychiatric emergency room visits have been reported [17,18,19]. Acute associations between air pollution and suicide attempts, [20] air pollution and suicide completion, [21, 22] air pollution and daily hospital admissions for psychiatric disorders [23], psychosis morbidity, [24] and air pollution and aggravated depressive symptoms [25,26,27] have been reported
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