Mental health and psychosocial interventions in the context of climate change: a scoping review

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Overview of academic literature findings

In total, 5126 unique records were identified (5107 from databases and 19 from backward citation hand search) (Fig. 1). Among the 194 records reviewed in full, 16 met inclusion criteria and were included in the review (Table 2). The 16 studies described 13 unique stand-alone interventions or packages of interventions across Asia, Europe, North America and the Caribbean, Oceania, and Sub-Saharan Africa. Among the studies, 7 (44%) were conducted in LMIC settings. All studies were published in or after 2009, with half (50%) having been published within the past 3 years (2019–2022).

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Table 2 List of records identified through academic literature search (n = 16).

Climate stressors included general climatic change, wildfires, droughts, cyclones, typhoons, and floods. Targeted mental health outcomes included psychological distress, psychiatric symptoms (depression, anxiety, PTSD), and broader psychological wellbeing measures such as emotional strength, emotional self-efficacy, confidence in the future, and general mental and spiritual wellness. Nine (56%) studies involved a type of design (e.g., RCT, quasi-experimental, pre-post) aimed to quantitatively evaluate the interventions, and 7 (44%) reported effectiveness results. Eleven (69%) studies mentioned a co-design process, during which local stakeholders were consulted for the needs assessment, intervention design, and/or cultural adaptation of the intervention.

Description of interventions from academic literature

Five microsystem interventions were identified that primarily focus on individual-level emotions, behaviors, and psycho-emotional resilience.

In Nigeria, where increasingly frequent floods are being attributed to climate change, an evaluation of a rational emotive behavior therapy (REBT) program was conducted22. REBT is a short-term therapy related to cognitive behavioral therapy (CBT) and encourages participants to actively dispute irrational beliefs after experiencing an undesirable triggering event. REBT was delivered over 20 sessions to 49 flood victims with clinical depression by professional therapists. In comparison to the waitlist control group, the intervention group was found to have significantly decreased depression symptoms as measured by the Hamilton Depression Scale (F(1,97) = 208.935, p = 0.001, ηp2 = 0.69) and by the Goldberg’s Depression Scale (F(1,97) = 34.842, p = 0.001, ηp2 = 0.27) and at 3-month follow-up.

In Haiti, a disaster-prone country susceptible to climate change effects, an integrated community intervention was developed to promote mental health and improve practical disaster preparedness23. The intervention was manualized and consisted of activities that promote mental health literacy and coping skills (e.g., progressive muscle relaxation), and increase household-level preparedness (e.g., developing emergency action plan, mapping community risks and resources). The intervention was delivered by local lay workers over 3 days to 144 individuals who recently experienced a hurricane and associated flooding. In comparison to the control group, intervention participants experienced fewer depression (B = −0.35, p < 0.001), anxiety (B = 0.27, p < 0.001), and PTSD (B = −0.46, p < 0.001) symptoms, and increased mental health-focused help-giving intention (B = 2.62, p < 0.001).

Several interventions identified themselves as resilience-building programs. In the Philippines, a six-module intervention Katatagan was developed in the aftermaths of the Super Typhoon Haiyan and evaluated in two settings24,25. In Tacloban City where trained paraprofessionals delivered the intervention, the 48 intervention participants experienced lower anxiety scores (F(1,105) = 3.89, p = 0.05, ηp2 = 0.036), increased adaptive coping (F(2.79,192.6) = 5.87, p = 0.001, ηp2 = 0.078), and increased individual resilience (F(1,105) = 4.68, p = 0.03, ηp2 = 0.043)24 in comparison to the control group. In the Samar Province, the intervention was delivered as part of a mission trip by Health Futures Incorporated (HFI). The 163 intervention participants improved in all self-efficacy domains, as measured by a locally constructed scale based on each Katatagan module, in comparison to the participants’ baseline. Reported effect sizes ranged from Cohen’s d = 0.33 for Engaging in Positive Activities, Cohen’s d = 0.51 for Managing Thoughts and Emotions, to Cohen’s d = 0.83 for Seeking Solutions and Support25. Benefits were largest immediately post-intervention and decreased at six-month follow-up in both settings.

Skills for Life Adjustment and Resilience (SOLAR) is another resilience-building intervention that was piloted in Tuvalu, a small island developing state (SIDS) vulnerable to sea-level rise26. Forty-nine islanders impacted by Cyclone Pam and experiencing mental health symptoms participated in the lay-worker-delivered group intervention over 5 consecutive days. Module content included Skills for Healthy Living, Managing Strong Emotions, Getting Back into Life Following Disaster, Coming to Terms with Disaster, Managing Worry and Rumination, and Maintaining Healthy Relationships. In comparison to controls, participants experienced improvements in psychological distress (Glass’s d = 1.106), PTSD symptoms (Glass’s d = 1.575), and functional impairment (Glass’s d = 1.316). Benefits were retained at six-month follow-up but were reduced compared to immediate post-intervention.

One review study narratively described an Environmental Health Clinic based at New York University27,28. Individuals concerned about environmental issues received “prescriptions” to participate in environmental projects, with the aim to channel anxiety to specific climate action. This intervention was used as an example of structured problem-based coping and no evaluation was available.

Four mesosystem interventions were identified that involve focuses beyond individual-level changes, and additionally target peer group relationships and local community identity and cohesion in relation to mental health and wellbeing.

Carbon Conversations is a UK-based third-sector initiative which allows individuals to reflect on difficult emotions around climate change, and in turn be better able to engage with carbon footprint reduction29. Groups of six to eight participants meet with two facilitators over six sessions and discuss themes pertaining to Climate Change and Low Carbon Futures, Energy in the Home, Travel and Transport, Food and Water, and Consumption and Waste. In an online survey to 113 group participants, 50% agreed or strongly agreed that taking part helped them “face their worries about climate change”. Semi-structured interviews further revealed themes that the intervention allowed participants a unique space to express and share difficult emotions around climate change, feel more empowered and in control, and engage with others with similar experiences.

In various parts of the world vulnerable to extreme weather and regional food security, multiple interventions involving community-level participatory activities have been developed. These include: (1) land restoration work and associated reflection exercises for youth living at the Arizona-Mexico border in the United States; (2) community garden hubs with tree-planting activities for low-income residents and people with chronic and mental health conditions in Australia; and (3) traditional fish camp activities and participatory research for indigenous youth of the Selkirk First Nation in Canada30,31,32. All interventions were designed in the context of climate change to improve psychological and/or spiritual wellbeing, and to promote connectedness among participants through shared identities. Internal program evaluations of the land restoration and community garden interventions both anecdotally suggest improved mental health outcomes among participants, though the specific evaluative methods and outcome measures were not reported.

Two packages of exosystem interventions were identified that involved the implementation of multi-pronged mental health services and mobilization of the media and local institutions.

In Sonoma County, California, the Sonoma Wildfire Mental Health Collaborative was established following the historic 2017 wildfires33,34. The Collective launched a package of interventions that included a trauma-informed yoga and meditation program, a mental health app targeting adolescent survivors, and a Skills for Psychological Recovery (SPR) training program for counselors and paraprofessionals. The package was coupled with a media campaign to raise post-disaster mental health awareness, destigmatize help-seeking, and promote available resources. Given small sample sizes, the evaluative study was unable to conclude the effects of the app or SPR training; a preliminary survey suggested that participants experienced short-term beneficial effects from the yoga and meditation program.

For the rural farming populations who face climate-related adversity in New South Wales, Australia, a government-funded Drought Mental Health Assistance Package (DMHAP) was implemented35,36. DMHAP consisted of mental health promotion (e.g., resource booklet development, community mental health forums, mental health first aid trainings) and early intervention (e.g., rural telephone support line, service network planning workshops). Following renewed funding, the extended Rural Adversity Mental Health Program (RAMHP) increased the number of dedicated drought mental health workers and introduced specific activities for priority groups, including women, youth, older farmers, and Aboriginal communities. The authors reported that given funding limitations, no formal outcome evaluation was carried out.

Two macrosystem interventions were identified that involved macro-level interventional components, primarily through poverty reduction to improve mental health and wellbeing outcomes.

In Bangladesh, a Red Cross Red Crescent humanitarian project was delivered to promote financial security and associated psychological benefits among river basin communities amidst the 2017 floods37. A forecast-based unconditional cash transfer of BDT 5000 (USD 60 equivalent) was distributed to 1039 poor households prior to a flood peak. Relative to the unassisted households, intervention households were less likely to have always felt anxiety and depression (43% vs 29%, p = 0.015) and less likely to have always felt miserable or unhappy (61% vs 40%, p < 0.01) since the flood. While these findings were triangulated with qualitative interviews, the authors noted that the intervention benefits were not sustained after a second flood peak in the same year.

In Ethiopia, a capacity-building intervention was developed for pastoral communities who face increasingly severe droughts, land changes, and food crises. The intervention included components to inspire motivation, build collective-action groups, and improve literacy and numeracy38. The macro-economic components specifically involved the promotion of microenterprises and distribution of donor grants for livestock trading. The study reported the creation of 59 primarily women-led collective-action groups, 11 of which received donor grants. Following a major drought, intervention participants who received both capacity building and donor grants in the Liben District scored much higher on study-defined mental health and wellbeing attributes than their peers. The attributes included better ability to recover from crisis (OR = 91.7, p < 0.001), more confidence in the future (OR = 33.6, p < 0.001), and better human health (OR = 19.2, p < 0.001). The positive findings were replicated in the Moyale District with smaller effect sizes.

Overview of gray literature findings

Targeted database search, Google search, and targeted website search identified 14 records describing 14 organizations offering relevant stand-alone and/or packages of interventions. One of the interventions (Carbon Conversations) was already identified through academic literature. A list containing these interventions, along with the inclusion and exclusion criteria, was circulated to 30 international content experts for consultation; through snowballing, we were introduced to and contacted 6 additional experts. Of all individuals contacted, 26 (72%) responded to the gray literature search request, and 8 (31%) of the respondents were based in a LMIC setting. The content experts reviewed and confirmed the list of interventions and identified 11 additional records for inclusion (total records = 25; minus duplicate = 24) (Table 3).

Table 3 List of records identified through gray literature search (n = 24).

All identified interventions are offered by an organization, and all but two were founded or based in a high-income country (HIC), primarily the US (46%) or the UK (33%). For the organizations that cited their founders, a large majority (11/12; 92%) of those founders are women.

The climate stressors addressed by interventions from the gray literature all involve general climatic changes and/or anticipated climate-related threats rather than specific climate-related disasters. Targeted mental health outcomes are independently defined by the organizations rather than by psychiatric diagnoses or standardized instruments, and many used emotion-based wordings such as “overwhelm”, “despair”, and “loneliness”. Five records (21%) described a co-design process involving local stakeholders.

Description of interventions from gray literature

The 24 interventions or packages of interventions acted at the levels of microsystem and mesosystem. No exosystem or macrosystem interventions were identified through gray literature. Of note, none of the interventions reported formal evaluation methods; a minority (12.5%) reported selected positive internal evaluation results.

Four microsystem interventions were identified that take a self-guided approach and support individuals to improve their own mental health and wellbeing in the context of climate change.

In the UK, a group of organizations, namely Climate Cares based at Imperial College London, Force of Nature and Common Vision worked with young people and environmental scientists to create a virtual intervention Hold This Space39. The interactive website guides youth to explore their feelings towards climate change, imagine the world they would like to see based on the latest science, and reflect on how to act on environmental issues most concerning to them. In consultation with youth advisors, mental health practitioners, and climate change professionals, Climate Cares also co-designed a 4-week activity-based physical journal40. The goal is to reduce the mental health impacts that can be associated with climate-related distress, build coping strategies, envision a desired future, and increase capability to take desired action. The Climate Journal Project based in the US is another intervention involving a journaling approach41. The organization created digital and printed journals and worksheets that target eco-anxiety and environmental grief. Individuals have the additional option of participating in virtually guided “journal circles”. Other self-guided activities and worksheets were identified through Eco-Anxious Stories, a Canada-based online platform42. In the “Sharing Our Stories” worksheet, individuals are prompted to answer questions such as “Where is eco-anxiety showing up in my life?” and “What does a meaningful response to this crisis look like and feel like?”

The rest of 20 gray literature records all acted at the level of the mesosystem and involve a group-based or outreach approach that harness the power of group dynamics and community building.

Many of the interventions function on the premise of offering a safe space for individuals to gather and make sense of their positive or negative climate emotions. As a quintessential example, Climate Cafés are decentralized, drop-in meetings for discussing the climate crisis and building collective psycho-emotional resilience – often over tea or coffee. The model of Climate Cafés is now adopted by many organizations globally with both in-person and virtual meetings available43,44,45. The Good Grief Network developed an intervention based on the 12-Step approach of Alcoholics Anonymous46. Trained peer facilitators deliver the 10-week group program for individuals interested in recognizing and exploring their eco-distress and being supported to move towards meaningful action. The Network’s website reports that over 90% of program participants feel more empowered and less alone, though the exact survey methods or number of surveyed participants are not available publicly. Other examples of facilitated discussions include All We Can Save Circles (10 structured sessions)47, Climate Emotions Conversations by Climate Awakening (3 available sessions per month)48, and The Rest of Activism (2 available sessions per week)49. A few interventions name their specific target audience: Conceivable Future “house parties” are intended for individuals who wish to discuss reproductive decisions and parenthood while facing an uncertain future50, and Globe and Psyche conversation meetings are intended for individuals working in psychotherapeutic and psycho-spiritual domains to reflect on professional identities and healings for others51.

Five identified organizations offer packages of interventions (e.g., facilitated workshops, events, trainings, online communities) under the same theoretical or philosophical premise. The Work That Reconnects (WTR) is a network based on Joanna Macy’s work, also known as Deep Ecology Work and Active Hope. The work’s philosophical premise follows a spiral sequence of four stages, “gratitude”, “honoring our pain for the world”, “seeing with fresh eyes”, and “going forth”, and is designed to be delivered in an interactive group setting52. The Deep Adaptation Forum is based on Jem Bendell’s work53, which recognizes the “breakdown” from climate change and aims to support individuals to prepare for and co-create a loving response to what Bendell describes as the “inevitable near term societal collapse”. The Resilient Activist is based on the “Five Essentials” principle (Reconnect to Nature, Respect All Life, Regreen Our Planet, Revamp Our Spending, and Replenish Our Resources) to maintain a healthy mindset and ease the emotional burden from climate change45. The Transition Network offers a variety of interventions (e.g., “Heart and Soul” groups) based on the Inner Transition principle, which posits that shifts in emotional and psychological dimensions are needed to make outer systemic changes towards healthier communities54. One Earth Sangha is a hub for spiritual-psychological participatory groups and events in response to climate change based on Buddhist teachings55.

Seven interventions involve outreach or capacity-building approaches to improve the participants’ mental health and wellbeing and/or that of their wider community. Force of Nature runs training programs for youth affected by eco-anxiety. The trained youth then have the opportunity to run group “anxiety-to-agency” workshops, and become speakers or consultants for businesses and educators on matters related to climate change56. The Resilience Project UK also offers a program for young people, who then become leaders of an 8-week Circle to co-design resilience-building programs for other youth57. Project InsideOut is an online hub with interactive tools and resources, allowing individuals who experience climate emotions to undergo an inner transformation before becoming “Guides” for others and leading climate action58. Eco-Anxious Stories, Climate Psychology Alliance, Circularity, and The Resource Innovation Group (TRIG) all list eco-anxiety outreach services (e.g., speaker hub, trainings, workshops, resource development) for schools, organizations, and communities42,44,59,60.

Only two identified interventions at this level are based in a LMIC setting. In Nigeria, The Eco-Anxiety in Africa Program (TEAP) is managed by Sustyvibes – a non-profit climate activism organization. Reported TEAP activities include the creation of virtual and physical spaces to stimulate dialogs on climate change and mental health (e.g., “Sustyparties” that use poetry and open mic settings to facilitate the sharing climate emotions)61. In Cameroon, the Ibanikom Climate Mental Health Literacy Project facilitated meetings for flood-affected communities, allowing participants to learn about the effects of climate change on mental health and co-develop local, small-scale culturally relevant integrated health and agriculture projects62.

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